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Fluoroquinolone‐induced immune thrombocytopenia: a report and review
Author(s) -
Cheah C. Y.,
De Keulenaer B.,
Leahy M. F.
Publication year - 2009
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2009.01996.x
Subject(s) - medicine , immunology , platelet , antibody , thrombocytopenic purpura , drug , immune system , pneumonia , pharmacology
Fluoroquinolones are an emerging but underrecognized cause of drug‐induced thrombocytopenia. Due to their broad spectrum they are often used in empirical treatment of febrile neutropenic, thrombocytopenic patients following myelosuppressive chemotherapy. They are associated with a range of immunohaematopathology. A 76‐year‐old male developed severe thrombocytopenia following treatment with ciprofloxacin on two occasions for community‐acquired pneumonia. The temporal association, response to dechallenge, dramatic response to rechallenge and exclusion of other causes combined with detection of platelet‐reactive antibodies of the immunoglobulin G class against glycoprotein IIb/IIIa following ciprofloxacin rechallenge makes causality probable. We present a brief review of immunohaematopathology associated with fluoroquinolones and draw attention to the structural similarity between quinolones and quinine to explore potential mechanisms for the phenomenon. Fluoroquinolones can induce drug‐dependent, platelet‐reactive antibodies causing complement‐mediated destruction of platelets. The underlying mechanism to explain this is unclear; however, we hypothesize that the chemical similarities shared with quinine may be contributory. When using these agents clinicians should be aware of the possibility of drug‐induced thrombocytopenia or thrombotic thrombocytopenic purpura.