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Tao E, Zhou H, Zheng M, Zhao Y, Zhou J, Yuan J, Yuan T, Zheng C. Ceftriaxone-induced severe hemolytic anemia, renal calculi, and cholecystolithiasis in a 3-year-old child: a case report and literature review. Front Pharmacol 2024; 15:1362668. [PMID: 38560354 PMCID: PMC10978768 DOI: 10.3389/fphar.2024.1362668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Ceftriaxone is widely used in pediatric outpatient care for its efficacy against respiratory and digestive system infections, yet its increasing association with severe immune hemolytic reactions requires heightened vigilance from pediatricians. This report details a rare and severe case of ceftriaxone-induced severe immune hemolytic anemia (IHA), hemolytic crisis, myocardial injury, liver injury, renal calculi, and cholecystolithiasis in a previously healthy 3-year-old child. The child, treated for bronchitis, experienced sudden pallor, limb stiffness, and altered consciousness following the fifth day of ceftriaxone infusion, with hemoglobin (Hb) levels precipitously dropping to 21 g/L. Immediate cessation of ceftriaxone and the administration of oxygen therapy, blood transfusion, intravenous immunoglobulin (IVIG), and corticosteroids led to a gradual recovery. Despite initial improvements, the patient's condition necessitated extensive hospital care due to complications including myocardial injury, liver injury, renal calculi, and cholecystolithiasis. After a 12-day hospital stay and a 3-month follow-up, the child showed complete normalization of Hb and liver function and resolution of calculi. In children, ceftriaxone infusion may trigger severe, potentially fatal, hemolytic reactions. Pediatricians must promptly recognize symptoms such as pallor, limb stiffness, and unresponsiveness, indicative of ceftriaxone-induced severe IHA, and immediately discontinue the drug. Effective management includes timely blood transfusion, respiratory support, IVIG administration, and corticosteroids when necessary, along with rigorous vital signs monitoring. Continued vigilance is imperative, even after cessation of ceftriaxone, to promptly address any residual adverse effects.
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Affiliation(s)
- Enfu Tao
- Department of Neonatology and NICU, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
| | - Huangjia Zhou
- Department of Pediatrics, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
| | - Meili Zheng
- Department of Pediatrics, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
| | - Yisha Zhao
- Department of Pediatrics, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
| | - Junfen Zhou
- Department of Pediatrics, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
| | - Junhui Yuan
- Department of Pediatrics, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
| | - Tianming Yuan
- Department of Neonatology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang Province, China
| | - Changhua Zheng
- Department of Pediatrics, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
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Nham E, Ko JH, Jeong BH, Huh K, Cho SY, Kang CI, Chung DR, Peck KR. Severe Thrombocytopenia in a Patient with COVID-19. Infect Chemother 2020; 52:410-414. [PMID: 32342677 PMCID: PMC7533212 DOI: 10.3947/ic.2020.52.3.410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) outbreak is spreading rapidly all over the world, being a major threat to public health. Since clinical feature of COVID-19 has not been fully evaluated yet, empirical antibacterial agents are frequently combined for the treatment of COVID-19 in addition to antiviral agents, concerning co-existing bacterial pathogens. We experienced a case of severe thrombocytopenia with epistaxis and petechiae, while treating a COVID-19 patient with ceftriaxone, levofloxacin, and lopinavir/ritonavir. The platelet count decreased to 2,000/mm³ and recovered after discontinuation of the three suspected drugs. In treating a potentially fatal emerging infectious disease, empirical and/or experimental approach would be unavoidable. However, the present case suggests that the possibility of adverse effects caused by polypharmacy should also be carefully considered.
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Affiliation(s)
- Eliel Nham
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Young Cho
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol In Kang
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Le Turnier P, Navas D, Garot D, Guimard T, Bernard L, Tattevin P, Vandamme YM, Hoff J, Chiffoleau A, Dary M, Leclair-Visonneau L, Grégoire M, Pere M, Boutoille D, Sébille V, Dailly E, Asseray N. Tolerability of high-dose ceftriaxone in CNS infections: a prospective multicentre cohort study. J Antimicrob Chemother 2020; 74:1078-1085. [PMID: 30698733 DOI: 10.1093/jac/dky553] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/14/2018] [Accepted: 11/28/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Ceftriaxone is widely used to treat community-acquired CNS bacterial infections. French guidelines for meningitis in adults promote 75-100 mg/kg/day ceftriaxone without an upper limit for dosage, yet little is known about the pharmacology and tolerability of such regimens. PATIENTS AND METHODS A multicentre prospective cohort study was conducted in adult patients to assess the adverse drug reactions (ADRs) of high-dose ceftriaxone (i.e. daily dosage ≥4 g or ≥75 mg/kg) in CNS infections and to analyse their related factors. Drug causality was systematically assessed by an expert committee who reviewed the medical charts of all included patients. RESULTS A total of 196 patients were enrolled over a 31 month period. Median dosage and duration of ceftriaxone were 96.4 mg/kg/day (7 g/day) and 8 days, respectively. Nineteen ceftriaxone-related ADRs (mainly neurological) occurred in 17 patients (8.7%), with only one case of treatment discontinuation (biliary pseudolithiasis). In univariate analysis, older age, male gender, renal impairment and high trough ceftriaxone plasma concentration were associated with ceftriaxone-related ADRs. CONCLUSIONS High-dose ceftriaxone for CNS infection administered as recommended by French guidelines in adults was well tolerated overall, suggesting these recommendations could be applied and generalized. In patients with advanced age or renal insufficiency, prescription should be done with caution and therapeutic drug monitoring could be useful.
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Affiliation(s)
- Paul Le Turnier
- Department of Infectious Diseases, Nantes University Hospital and CIC 1413, INSERM, Nantes, France
| | - Dominique Navas
- EA 3826, University of Nantes, Nantes, France.,Pharmacy Department, Nantes University Hospital, Nantes, France
| | - Denis Garot
- Intensive Care Unit, Anaesthesia and Critical Care Department, Tours University Hospital, Tours, France
| | - Thomas Guimard
- Infectious Diseases Department, La Roche sur Yon Hospital, La Roche sur Yon, France
| | - Louis Bernard
- Infectious Diseases Department, Tours University Hospital, Tours, France
| | - Pierre Tattevin
- Infectious Diseases Department, Rennes University Hospital, Rennes, France
| | | | - Jérôme Hoff
- Intensive Care Unit, Anaesthesia and Critical Care Department, Saint Nazaire Hospital, Saint Nazaire, France
| | - Anne Chiffoleau
- Pharmacovigilance, Research Board, Nantes University Hospital, Nantes, France
| | - Martin Dary
- Emergency Department, Nantes University Hospital, Nantes, France
| | | | - Matthieu Grégoire
- EA 3826, University of Nantes, Nantes, France.,Clinical Pharmacology Department, Nantes University Hospital, Nantes, France
| | - Morgane Pere
- Biostatistics Unit, Research Board, Nantes University Hospital, Nantes, France
| | - David Boutoille
- Department of Infectious Diseases, Nantes University Hospital and CIC 1413, INSERM, Nantes, France.,EA 3826, University of Nantes, Nantes, France
| | - Véronique Sébille
- Biostatistics Unit, Research Board, Nantes University Hospital, Nantes, France
| | - Eric Dailly
- EA 3826, University of Nantes, Nantes, France.,Clinical Pharmacology Department, Nantes University Hospital, Nantes, France
| | - Nathalie Asseray
- Department of Infectious Diseases, Nantes University Hospital and CIC 1413, INSERM, Nantes, France
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Piedra Abusharar S, Shah N, Patel R, Jain R, Polimera HV. A Case of Confirmed Ceftriaxone-induced Immune Thrombocytopenia. Cureus 2019; 11:e4688. [PMID: 31338265 PMCID: PMC6639063 DOI: 10.7759/cureus.4688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Drug-induced immune thrombocytopenia (DITP) is a rare, but potentially fatal cause of isolated thrombocytopenia. DITP is thought to occur when drug-dependent antibodies bind to the platelet membrane glycoproteins to activate platelet consumption signaling. Common implicated drugs include quinine/quinidine, penicillamines, valproic acid and cotrimoxazole. Ceftriaxone is a rare culprit with only six reported cases since 1991, of which only three were confirmed with drug-dependent antiplatelet antibodies. We describe a case of antibody confirmed ceftriaxone-induced immune thrombocytopenia after initiation of empiric antibiotic therapy for acute bacterial meningitis.
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Affiliation(s)
- Shady Piedra Abusharar
- Internal Medicine, Penn State College of Medicine/ Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Neal Shah
- Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Ravi Patel
- Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Rohit Jain
- Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Hyma V Polimera
- Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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Vallatharasu Y, Hayashi-Tanner Y, Polewski PJ, Bottner WA, Rosenstein LJ, Uprety D, Bista A, Farnen JP, Aster R. Severe, prolonged thrombocytopenia in a patient sensitive to exenatide. Am J Hematol 2019; 94:E78-E80. [PMID: 30575104 DOI: 10.1002/ajh.25381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Yazhini Vallatharasu
- Department of Hematology and Medical Oncology; Gundersen Health System; La Crosse Wisconsin
| | - Yacki Hayashi-Tanner
- Department of Hematology and Medical Oncology; Gundersen Health System; La Crosse Wisconsin
| | - Peter J. Polewski
- Department of Hematology and Medical Oncology; Gundersen Health System; La Crosse Wisconsin
| | - Wayne A. Bottner
- Department of Hematology and Medical Oncology; Gundersen Health System; La Crosse Wisconsin
| | - Lori J. Rosenstein
- Department of Hematology and Medical Oncology; Gundersen Health System; La Crosse Wisconsin
| | - Dipesh Uprety
- Department of Hematology and Medical Oncology; Gundersen Health System; La Crosse Wisconsin
| | - Amir Bista
- Department of Hematology and Medical Oncology; Gundersen Health System; La Crosse Wisconsin
| | - John P. Farnen
- Department of Hematology and Medical Oncology; Gundersen Health System; La Crosse Wisconsin
| | - Richard Aster
- BloodCenter of Wisconsin; Blood Research Institute; Milwaukee Wisconsin
- Department of Medicine; Medical College of Wisconsin; Milwaukee Wisconsin
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Lu J, Li Q, Li X, Li Z. A Fatal Case Report of Ceftriaxone-induced Hemolytic Anemia and Literature Review in Pediatrics. INT J PHARMACOL 2018. [DOI: 10.3923/ijp.2018.896.900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Domingo-Chiva E, Díaz-Rangel M, Monsalve-Naharro JÁ, Cuesta-Montero P, Catalá-Ripoll JV, García-Martínez EM. Ceftazidime-induced thrombocytopenia. ACTA ACUST UNITED AC 2017; 64:590-593. [PMID: 28559046 DOI: 10.1016/j.redar.2017.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 11/19/2022]
Abstract
Ceftazidime is an antibiotic belonging to the group of third generation cephalosporins, frequently used in clinical practice for its broad antibacterial spectrum. A case report is presented on a 78-year-old man who entered the intensive care unit due to respiratory failure secondary to nosocomial pneumonia in the postoperative period of a laparoscopic hepatic bisegmentectomy for a hepatocarcinoma. It required invasive mechanical ventilation and was treated with ceftazidime, developing a progressive decrease in platelet count after the onset of this drug and after re-exposure to it, not coinciding with the introduction of other drugs. The adverse reaction was reported to the Spanish pharmacosurveillance system and according to the Naranjo algorithm the causal relationship was probable. Since no case of ceftazidime-induced thrombocytopenia was found in the literature, we consider knowledge of it relevant as an adverse effect to be taken into account given its potential severity, especially when it cannot be explained by other causes.
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Affiliation(s)
- E Domingo-Chiva
- Servicio de Farmacia Hospitalaria, Gerencia de Atención Integrada de Albacete, Albacete, España.
| | - M Díaz-Rangel
- Servicio de Farmacia Hospitalaria, Gerencia de Atención Integrada de Albacete, Albacete, España
| | - J Á Monsalve-Naharro
- Servicio de Anestesia, Reanimación y Terapéutica del Dolor, Gerencia de Atención Integrada de Albacete, Albacete, España
| | - P Cuesta-Montero
- Servicio de Anestesia, Reanimación y Terapéutica del Dolor, Gerencia de Atención Integrada de Albacete, Albacete, España
| | - J V Catalá-Ripoll
- Servicio de Anestesia, Reanimación y Terapéutica del Dolor, Gerencia de Atención Integrada de Albacete, Albacete, España
| | - E M García-Martínez
- Servicio de Farmacia Hospitalaria, Gerencia de Atención Integrada de Albacete, Albacete, España
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