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.