Profound thrombocytopenia associated with piperacillin in a hemodialysis patient

Piperacillin-induced thrombocytopenia, albeit reversible, is a life-threatening hematological emergency but easily overlooked. We describe a 78-year-old uremic man on regular hemodialysis who received intravenous administration of piperacillin (2 g) 3 times a day to treat nosocomial pneumonia. On the eighth day of therapy, isolated profound thrombocytopenia with a nadir value of 3 × 10³/mm³ was noticed. Physical examination revealed multiple bruises over puncture sites and petechiae over bilateral lower extremities. An exhaustive search for potential causes of thrombocytopenia was unrevealing. Upon withdrawal of piperacillin and immediate high-flux hemodialysis, platelet count rapidly normalized up to 215 × 10³/mm³ in 3 days. With the widespread use of piperacillin, early recognition of piperacillin-induced immune thrombocytopenia and prompt withdrawal of the causative antibiotic may achieve less morbidity.