SHM Converge Scientific Abstract ePoster Gallery-Management of Ciprofloxacin-Induced Immune Thrombocytopenia

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This case report describes a 78-year-old man hospitalized for two days of oral bleeding and found to have severe thrombocytopenia, with platelets initially 11,000/mcL and falling to 7,000/mcL. He had a history of COPD, BPH, and PTSD. Physical exam showed multiple bleeding oral ulcerations, and labs showed mild anemia and elevated BUN. A peripheral smear showed enlarged platelets and no schistocytes, supporting immune thrombocytopenia (ITP). The patient later became hypotensive and altered, requiring ICU care, norepinephrine, BiPAP, and platelet transfusion. A full-body CT ruled out occult bleeding.<br /><br />Hematology/Oncology evaluated the patient and started IV dexamethasone 40 mg daily. Despite this, his platelet count continued to decline to 5,000/mcL over the next several days. IVIG was then initiated, after which platelets gradually improved and returned to normal by hospital day 14. The remainder of the admission focused mainly on nursing home placement.<br /><br />The discussion emphasizes that ITP is a diagnosis of exclusion, requiring careful history, medication review, exam, and peripheral smear. Fluoroquinolones, including ciprofloxacin, are rare but recognized causes of drug-induced ITP. Initial management includes stopping the offending agent and transfusing platelets if needed. For severe cases, especially when platelets are below 10,000/mcL or there is bleeding, IV steroids or IVIG are used. In this case, steroids were ineffective, but IVIG was successful. The report notes that IVIG and IV steroids are generally considered similarly effective and interchangeable when one treatment fails.<br /><br />Overall, the case highlights the importance of considering medications as a trigger for severe thrombocytopenia and the need for close monitoring, hematology consultation, and rapid escalation of treatment when bleeding risk is high.

Asset Subtitle

Maximilian Choo

Meta Tag

Author List Maximilian Choo

Category Clinical Vignettes

Concept Fluoroquinolone-Induced Immune Thrombocytopenia

Concept Immune Thrombocytopenia

Concept Severe Thrombocytopenia

Concept Diagnosis of Exclusion

Concept Corticosteroids

Distinguished Non-Finalist

Presenter Organization East Alabama Medical Center

Presenting Author Maximilian Choo

Track Adult

Keywords

immune thrombocytopenia

severe thrombocytopenia

oral bleeding

platelet transfusion

IV dexamethasone

intravenous immunoglobulin

drug-induced ITP

ciprofloxacin

peripheral smear

hematology consultation

Fluoroquinolone-Induced Immune Thrombocytopenia

Immune Thrombocytopenia

Severe Thrombocytopenia

Diagnosis of Exclusion

Corticosteroids