1. INTRODUCTION
Drug-induced thrombocytopenia (DIT) has been described as a sudden and severe hematologic complication. The diagnosis of DIT remains a challenge because its etiology is complex and multifactorial. It can have fatal outcomes when a platelet count nadir below 100,000/µL and a decrease in platelet count of ≥30%.1 The incidence of DIT has been reported as 10 cases per million population per year, with a prevalence of approximately 25% in critically ill patients.2
Beta-lactam antibiotics are a relatively common cause of thrombocytopenia. Although beta-lactam antibiotics may decrease platelet production secondary to bone marrow suppression, drug-induced immune-mediated thrombocytopenia (DITP) is more common in this class.3 Thus, cross-reactivity may exist between beta-lactam antibiotics because of the immunogenic nature of DITP and the structural similarities between them. To date, some studies focused on case reports or series suggested that there was no cross-reaction of DITP between the penam group and the cephem group.4–6 However, these reports involved very few different beta-lactam antibiotics and did not identify responsible antibodies of DITP. Therefore, when a patient experiences DITP the question of whether an alternative member of beta-lactam antibiotics can safely be used often arises.
Here, we report a patient with piperacillin-tazobactam-induced immune thrombocytopenia can successfully challenge with meropenem and cefotiam, but cannot tolerant with cefoperazone-sulbactam.