A case report of severe thrombocytopenia caused by piperacillin-tazobactam in combination with voriconazole

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Author:  WANG Jinming ^1, ² LI Xueyan ³

Affiliation: 1.Department of Pharmacy, Taizhou Municipal Hospital, Taizhou University Affiliated Municipal Hospital, Taizhou 318000, Zhejiang Province, China 2.School of Medicine, Taizhou University, Taizhou 318000, Zhejiang Province, China 3.Department of Pharmacy, Yuhuan Hospital of Traditional Chinese Medicine, Yuhuan 317600, Zhejiang Province, China

Keywords: Piperacillin-tazobactam Voriconazole Thrombocytopenia Adverse reactions

DOI: 10.12173/j.issn.1005-0698.202509101

Reference: Wang JM, Li XY. A case report of severe thrombocytopenia caused by piperacillin-tazobactam in combination with voriconazole[J]. Chinese Journal of Pharmacoepidemiology, 2026, 35(6): 710-715.DOI: 10.12173/j.issn.1005-0698.202509101.[Article in Chinese]  Copied

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Abstract

A 73-year-old male patient with chronic obstructive pulmonary disease complicated by acute lower respiratory tract infection was treated with piperacillin-tazobactam 4.5 g, ivd, q8h for anti-infective therapy. The patient continued to cough and produce sputum one week after treatment. Bronchoscopy revealed a large amount of secretions, and metagenomic sequencing results indicated Aspergillus fumigatus positivity. Combining pulmonary aspergillosis was considered, and voriconazole tablets 200 mg, bid, po were added for antifungal treatment. After 4 days of treatment, the patient's platelet count (Plt) dropped sharply to 8×10⁹·L^-1, which was considered to be associated with piperacillin-tazobactam and voriconazole. Therefore, the suspected drugs were discontinued. After symptomatic treatment such as platelet transfusion and application of platelet boosting drugs, the patient's Plt gradually recovered. The association evaluation was conducted using Naranjo's Assessment Scale, and the result was "probable". This case suggests that for elderly patients with complex concomitant medications, clinical use of piperacillin-tazobactam requires careful consideration of concomitant medications and vigilance for severe thrombocytopenia. In the event of thrombocytopenia, prompt assessment, discontinuation of suspected drugs and symptomatic treatment are necessary to ensure medication safety.

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