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Intraperitoneal vancomycin-induced immune thrombocytopenia.

Ahmet Murt¹, Tuba Ozkan Tekin², Suleyman Sami Guzel³

¹Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey.

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|September 18, 2021

Summary

Severe thrombocytopenia occurred in a peritoneal dialysis patient treated with intraperitoneal vancomycin for peritonitis. Prompted by this rare vancomycin-induced immune thrombocytopenia, treatment adjustments led to recovery.

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Area of Science:

Nephrology
Pharmacology
Hematology

Background:

Peritoneal dialysis (PD) patients often develop peritonitis, requiring antibiotic treatment.
Intraperitoneal vancomycin is a common treatment for PD-related peritonitis, but systemic toxicity is not fully understood.
Vancomycin can be significantly absorbed systemically via the intraperitoneal route.

Observation:

A PD patient presented with peritonitis caused by methicillin-resistant staphylococci.
Intraperitoneal vancomycin was administered based on sensitivity testing.
The patient developed severe thrombocytopenia (platelet count 3,900/μl) after 10 days of vancomycin treatment.

Findings:

Clinical presentation and rapid drop in platelet count strongly suggested vancomycin-induced immune thrombocytopenia.
Initial treatments with dexamethasone and platelet transfusions were ineffective.
Intracranial bleeding complicated the clinical course.
High-dose methylprednisolone treatment led to gradual recovery of platelet levels.

Implications:

This case highlights a rare but serious adverse effect of intraperitoneal vancomycin in PD patients.
Early recognition and aggressive management, including high-dose corticosteroids, are crucial for favorable outcomes.
Further research into vancomycin's systemic absorption and toxicity profiles in PD is warranted.