Teicoplanin-Induced Thrombocytopenia

J.W. van der Pijl, MD, Department of Nephrology, University Hospital Leiden, PO Box 9600, NL-2300 RC Leiden (The Netherlands) tests for SLE disease, presence of an acute viral illness or dysfunction of the bone marrow were negative. On the sixth day of teicoplanin therapy the serum level was 32.6 mg/ 1, measured 5 h after administration. After discontinuation of teicoplanin, leukocytope-nia and thrombocytopenia recovered within 5 and 8 days respectively (fig. 1). Dear Sir, Teicoplanin is a glycopeptide antibiotic structurally related to vancomycin and effective against gram-positive microorganisms. Reported side effects are fever, allergic reactions, local pain at the infusion site, elevation of serum transaminase and creatinine levels, reversible eosinophilia, vestibulo-cochlear complaints and neutropenia [1, 2]. Thus far, only 1 case concerning thrombocytopenia associated with teicoplanin has been reported [3]. Herewith we present a second patient in whom this serious adverse event occurred. A 24-year old woman with a past medical history of SLE, hypertension and end-stage renal disease, was admitted because of fever after transplantectomy of a kidney. Four weeks earlier, a postmortal kidney had been transplanted in the left iliac fossa, but had been readily removed because of infarction 10 days later. Her medication on admission comprised prednisone 10 mg q.d., pravasta-tin 10 mg q.d. and hydroxychloroquine 5 times weekly 200 mg. With respect to the physical examination only fever (39.3 °C) and local tenderness in the left iliac region were present. Ultrasound investigation revealed a fluid collection in the left iliac fossa which could be evacuated in one session. Initial antibiotic treatment consisted of fluclox-acillin intravenously during 4 days, which was replaced by teicoplanin intravenously (loading dose: 400 mg, followed by 200 mg once a day), because final cultures yielded a coagulase-negative staphylococcus. Fever as well as severe thrombocytopenia (8-109/1) and leukocy topenia (1.5 · 109/l, 49 % granulo-cytes and 33% lymphocytes) occurred on the tenth day of teicoplanin therapy. Ancillary Flucloxacillin Teicoplanin < x 6 8 10 12 14 16 18 20 22 24DaysLeukocytes oThrombocyîes Fig. 1. Number of leukocytes and thrombocytes in relation to teicoplanin therapy. Both sera from the patient during treatment and after stopping the drug were tested for teicoplanin-induced antibodies reactive with autologous platelets by indirect immu-