title: Life-threatening haematuria caused by vancomycin-induced thrombocytopenia.
abstract: Thrombocytopenia is a rare side effect of vancomycin, an antibiotic that is often used to treat Gram-positive bacterial infections. A 67-year-old man developed bilateral pulmonary emboli and hospital-acquired pneumonia following left ureteric reimplantation. He was anticoagulated with rivaroxaban and started on intravenous vancomycin and gentamicin for treatment of pneumonia. After five doses of vancomycin, his platelet count dropped to a nadir of 0 × 10(9)/L (baseline: 314 × 10(9)/L) manifesting as visible heavy haematuria and haemodynamic instability due to excessive blood loss. Reversal of the thrombocytopenia was achieved with intravenous immunoglobulin, methylprednisolone and continuous platelet transfusions.
authors.affiliation: Guy's and St Thomas' NHS Trust, London, UK.
authors.forename: Niyati
authors.initials: N
authors.lastname: Lobo
authors.affiliation: Guy's and St Thomas' NHS Trust, London, UK.
authors.forename: Kandi
authors.initials: K
authors.lastname: Ejiofor
authors.affiliation: Guy's and St Thomas' NHS Trust, London, UK.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Thurairaja
authors.affiliation: Guy's and St Thomas' NHS Trust, London, UK.
authors.forename: Muhammad Shamim
authors.initials: MS
authors.lastname: Khan
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003428:Cross Infection; D006417:Hematuria / Q000139:chemically induced*; D006801:Humans; D007049:Iatrogenic Disease; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D010976:Platelet Count; D011014:Pneumonia / Q000188:drug therapy*; D012092:Replantation / Q000379:methods*; D013921:Thrombocytopenia / Q000139:chemically induced*; D016896:Treatment Outcome; D014513:Ureter / Q000293:injuries / Q000601:surgery*; D013520:Urologic Surgical Procedures; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D014640:Vancomycin; D008775:Methylprednisolone