万古霉素致免疫性血小板减少症1例

A case report of vancomycin-induced immune thrombocytopenia

该文报告1例68岁女性患者,因“反复发热2年”入院,既往有慢性肾脏病(5期)病史,接受维持性血液透析2年。应用万古霉素抗感染治疗15 d后出现外周血血小板计数陡降至<1×10^(9)/L。结合临床表现及血小板抗体筛查等相关检查结果,考虑万古霉素致血小板减少症。立即停用万古霉素,采用积极血浆置换为主的治疗方案,最终患者外周血血小板计数恢复正常,支持万古霉素致血小板减少症诊断。万古霉素在透析患者中应用广泛,临床医师们应认识到万古霉素致血小板减少症这一罕见但严重的不良反应,一旦出现应及早停药并实施个体化治疗,规避患者大出血或死亡的风险。

The paper reports a 68-year-old female patient admitted with"recurrent fever for 2 years"with a previous history of chronic kidney disease(stage 5)and receiving maintenance hemodialysis for 2 years.After 15 days of anti-infection treatment with vancomycin,the patient showed a steep drop in peripheral platelet count to<1×10^(9)/L.Combined with the clinical manifestations and platelet antibody screening,considering vancomycin-induced thrombocytopenia(VIT),vancomycin was immediately stopped,and active plasma exchange was adopted.Finally,the peripheral blood platelet count of the patient returned to normal,supporting the diagnosis of VIT.Vancomycin is widely used in dialysis patients,and the clinicians should be aware of the rare but severe adverse effect of VIT.Once present,vancomycin should be stopped early and individualized treatment should be taken to avoid the risk of massive bleeding or death.