Related Experiment Videos
Vancomycin-induced thrombocytopenia: a challenge and rechallenge
C E Howard1, L A Adams, J L Admire
1McWhorter School of Pharmacy, Samford University, Birmingham, AL 35229, USA.
Objective:
To report a case of thrombocytopenia apparently associated with vancomycin use.
Case Summary:
A 58-year-old white man was admitted to the hospital with chronic osteomyelitis of the foot due to methicillin-resistant Staphylococcus aureus that later spread hematogenously to the cervical vertebrae. During the first course of therapy with vancomycin, his platelet count decreased from 397 x 10(3)/mm3 to 22 x 10(3)/mm3. After discontinuation of the drug, it increased to 310 x 10(3)/mm3. During the second course of vancomycin, the platelet count decreased to 77 x 10(3)/mm3, and increased to 404 x 10(3)/mm3 after discontinuation of the drug.
Discussion:
Vancomycin has been reported as a rare cause of thrombocytopenia. Thrombocytopenia can occur as an adverse drug reaction by the following three mechanisms: direct toxic effect, drug absorption (hapten) formation, and an "innocent bystander" immune response.
Conclusions:
We suspect that the thrombocytopenia in this patient, which involved an increased number of megakaryocytes in the bone marrow, was due to vancomycin.