A Case of Ampicillin-Induced Thrombocytopenia in a Patient with Double-Valve Endocarditis

Abstract

Introduction: We report about a 66-year-old male patient, who underwent SAVR in October 2013. In May 2015, the patient presented at the emergency department with dyspnea (NYHA III) and fever. Due to suspected pneumonia he was treated at another institution with Tazobactam and Piperacillin. The echocardiographic examination showed a double valve endocarditis. The antibiotic regime was continued until surgery. After an uneventful redo double valve replacement (aortic/mitral) the antibiotic regime was adapted to the antibiogram to Gentamycin and Ampicillin due to enterococcus faecalis. After initiating the antibiotic regime thrombocyte platelet count showed normal values of 222 Mrd/L and started to drop from postoperative day 2 (Fig. 1). At day 5 the platelet count was 5 Mrd/L. Initial hypothesis was HIT II or DIC, which was excluded after coagulation check, as well as a hemato-oncologic disease or Lupus anticoagulant. An antibiotic-induced thrombocytopenia was taken into consideration and ampicillin administration was replaced through Vancomycin at day 10. Thrombocytes started to rise immediately and showed normal values of 200 Mrd/L 2 days after. At no time point the patient showed any signs of bleeding or cognitive limitations.