Acyclovir‑induced immune thrombocytopenia: Case report and review of the literature

Fekete,Gyula   László; Fekete,László; Ancuceanu,Robert; Ianoși,Simona   Laura; Drăgănescu,Miruna; Brihan,Ilarie

doi:10.3892/etm.2020.8971

Acyclovir‑induced immune thrombocytopenia: Case report and review of the literature

Authors:
- Gyula László Fekete
- László Fekete
- Robert Ancuceanu
- Simona Laura Ianoși
- Miruna Drăgănescu
- Ilarie Brihan
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Affiliations: Department of Dermatology, Dermatology Clinic, ‘George Emil Palade’ University of Medicine, Pharmacy, Science and Technology, 540139 Târgu Mureș, Romania, Department of Pharmaceutical Botany and Cell Biology, Faculty of Pharmacy, ‘Carol Davila’ University of Medicine and Pharmacy, 020956 Bucharest, Romania, Department of Dermatology, University of Medicine and Pharmacy, 200349 Craiova, Romania, Medical Department, Faculty of Medicine and Pharmacy, University ‘Dunărea de Jos’, 800010 Galati, Romania, Department of Dermatology, Dermatology Clinic, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
Published online on: July 7, 2020 https://doi.org/10.3892/etm.2020.8971
Pages: 3417-3420

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Abstract

There are a number of medications which can serve as catalysts for drug‑induced immune thrombocytopenia (DIPT). A minimum of six different mechanisms have been put forward as the means by which drug‑induced antibodies can encourage platelet destruction, thus emphasising the complexity of the pathogenesis of DITP. Acyclovir, has been widely used because of its highly potent prohibitive properties for infections caused by HSV and VZV. The common adverse effects of this drug are well known, the severe adverse reactions are mostly related to high dose intravenous administrations. The immune thrombocytopenia induced by acyclovir is unusual. The authors present a rare clinical case of acyclovir‑induced immune thrombocytopenia in a 72‑year‑old female patient with typical herpes zoster treated with acyclovir. The clinical and laboratory findings, taken together with the transitory relationship between acycolvir and the start of thrombocytopenia, combined with the elimination of the other know sources of thrombocytopenia, allowed us to reach the diagnosis of acyclovir‑induced immune thrombocytopenia. An international database search was employed to complete an extensive review of the current literature. Contemporary information on acyclovir‑induced immune thrombocytopenia was collected by the analysis of present day review articles and accessible case reports. The authors found five published cases of acyclovir‑induced immune thrombocytopenia. Analyzing these articles it was concluded that immune thrombocytopenia induced by acyclovir is rare, and an unusual side effect, with good prognosis. Prompt diagnosis is vital to appropriate management, therefore clinicians need to be cognisant of this rare potential adverse reaction.

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