Jornal de Toxicologia Clínica
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Suspected Vancomycin-Induced Thrombocytopenia in a Patient with Intracranial Hemorrhage

Hannah Y Chan, Teresa A Allison, Miguel A Escobar, R Bertani

Vancomycin-induced thrombocytopenia is a rare adverse reaction that has been reported in only a select few amounts of medical literature. We describe a case of a critically-ill patient with suspected vancomycin-induced thrombocytopenia who experienced severe thrombocytopenia seven days after discontinuation of vancomycin in the setting of an intracranial hemorrhage. A 48-year old man was admitted to the hospital after complaints of weakness and aphasia, found to have a large basal ganglia hemorrhage. During his hospital course, vancomycin therapy was initiated for suspected infection. On day 7 of empiric treatment, the patient developed thrombocytopenia with a nadir value of 4,000/mm³ with symptoms of active bleeding. It is suspected that vancomycin-induced thrombocytopenia may be derived from an immunological-mediated process. As vancomycin is a commonly-used treatment option for a growing emergence of methicillin-resistant Staphylococcus aureus, clinicians should focus on the work-up of thrombocytopenia in the setting of the intensive care unit and vancomycin usage.