Case
Published · Updated · 2 min read
Severe thrombocytopenia after piperacillin/tazobactam re-exposure in a patient with COVID-19
What it means for practice
Consider piperacillin/tazobactam as a possible cause of severe thrombocytopenia in critically ill patients, particularly after re-exposure, even in the presence of COVID-19.
Summary
A case report describes severe thrombocytopenia in a 73-year-old woman with multiple comorbidities who was hospitalized with COVID-19. During admission, she received several antibiotics, including piperacillin/tazobactam. In the following days, severe thrombocytopenia developed upon re-exposure to this combination.
Clinical course and causality assessment
The authors report that other causes of thrombocytopenia were systematically excluded. Thrombocytopenia resolved after piperacillin/tazobactam was discontinued and intravenous immunoglobulin was administered. The Naranjo score was 6 points, indicating a probable adverse drug reaction. The abstract does not provide platelet counts, exact intervals between re-exposure and reaction onset, or the time to recovery.
Practical implication
The authors emphasize considering piperacillin/tazobactam as a potential cause of severe thrombocytopenia in critically ill patients, even with confounding factors such as COVID-19. They describe this presentation in patients with recent COVID-19 as rarely reported. Further studies are needed to clarify the relationship between COVID-19 and drug-induced thrombocytopenia.
Case analysis
- Likely mechanism
- A generally accepted possible mechanism is immune-mediated platelet destruction involving drug-dependent antibodies. This is a general pharmacological explanation; the abstract does not establish the mechanism in this patient.
- Causality assessment
- The authors reported a Naranjo score of 6 points, indicating a probable adverse drug reaction. They described thrombocytopenia after re-exposure, exclusion of other causes, and resolution after withdrawal of the combination and administration of intravenous immunoglobulin.
- Take-home lesson
- Include piperacillin/tazobactam among the possible causes of severe thrombocytopenia, particularly after re-exposure. COVID-19 and comorbidities do not exclude a drug-related cause.
Source
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Alharthi AF, Alkathiri MA, Alomeir O, et al. Severe Thrombocytopenia Induced by Re-Exposure to Piperacillin/Tazobactam: A Case Report in Critically Ill Patient With COVID-19. Clin Case Rep. 2026;14(11):e73787. doi:10.1002/ccr3.73787
PubMed 42964650 DOI 10.1002/ccr3.73787 Original: pubmed.ncbi.nlm.nih.gov
Reviewed by: DrugCard editorial team ·
This article does not replace clinical judgement. Disclaimer
