Annals of Pharmacotherapy | 2019
Ceftaroline-Induced Thrombocytopenia: A Case Report
Abstract
Drug-induced thrombocytopenia is an uncommon but potentially serious adverse effect of medications. Some βlactams, such as ceftriaxone, are known to be associated with thrombocytopenia. This report describes a probable case of thrombocytopenia caused by ceftaroline therapy. An 83-year-old woman with a past medical history of myelodysplastic syndrome, sick sinus syndrome with a pacemaker (PM), and coronary artery disease was diagnosed at an outside hospital with methicillin-resistant Staphylococcus aureus (MRSA) endocarditis from an infected peripheral line. The patient received a 6-week course of daptomycin, which resulted in negative blood cultures but was complicated by renal failure requiring hemodialysis. Three days after treatment completion, the patient represented with dyspnea, fever, and encephalopathy and was found to have recurrent MRSA bacteremia with a new vegetation on the right ventricular PM lead. The hemodialysis line was removed, and the patient was transferred to Beth Israel Deaconess Medical Center. Treatment was initiated with vancomycin, but a vancomycin minimum inhibitory concentration (MIC) of 2 μg/mL resulted in a change to daptomycin 8 mg/kg every 48 hours (MIC ≤ 0.25 μg/mL, creatinine clearance 25 mL/min off hemodialysis). A baseline platelet count was 191 000 cells/μL. On hospital day 2, the patient underwent PM explantation and temporary PM placement. On hospital day 4, the patient continued to have persistent MRSA bacteremia and was transitioned to ceftaroline 300 mg every 8 hours. On hospital day 11 (day 8 of ceftaroline), the patient developed thrombocytopenia (platelets < 150 000 cells/μL, nadir 129 000 cells/μL). To facilitate discharge, on hospital day 15, the patient was transitioned back to daptomycin, with thrombocytopenia resolving over the following week. The patient developed a rash, transaminitis, and eosinophilia on day 15 of daptomycin and was transitioned back to ceftaroline. Thrombocytopenia developed on day 3 of therapy (platelets nadir 95 000 cells/μL). The patient completed 4 weeks of ceftaroline and/or daptomycin therapy. A recent MRSA isolate displayed a vancomycin MIC of 1 μg/mL; therefore, ceftaroline was discontinued, and vancomycin was restarted. Platelets continued to increase while in-house and postdischarge (Figure 1). The patient successfully completed a 6-week course post-PM explantation with no further adverse events. 835208 AOPXXX10.1177/1060028019835208Annals of PharmacotherapyBritt et al letter2019