A Case of Ceftaroline-Associated Thrombocytopenia

Ceftaroline is a fifth-generation cephalosporin that can be used for the treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA). A rare adverse effect of ceftaroline therapy is thrombocytopenia. Our case involves a 45-year-old male with active intravenous drug usage who presented with persistent fever, lower back pain, and left elbow pain. His bloodcultures were found to be positive for MRSA. He was initially started on vancomycin; subsequently, the antibiotic was changed to daptomycin and ceftaroline, as vancomycin failed to clear the bacteremia. Seven days after initiation of ceftaroline, it was unintentionally discontinued by the electronic health record. Following its resumption two days later, the patient started having epistaxis accompanied by an acute drop in his platelet count from 422,000 cells/µL to less than 2,000 cells/µL. The ceftaroline therapy was discontinued, and he received a platelet transfusion. However, daptomycin was continued, resulting in successful resolution of his bacteremia. The patient's platelet count at discharge improved to 582,000 cells/µL. The patient was diagnosed with ceftaroline-induced thrombocytopenia, and it was added to his list of allergies.