Intraperitoneal vancomycin-induced immune thrombocytopenia.

Vancomycin is one of the drugs used in the peritonitis treatment regimen of peritoneal dialysis patients. Intraperitoneal route is generally preferred to provide rapid elimination of infective agents. Systemic toxicities of certain drugs after intraperitoneal administration are not very clear. The same also applies to vancomycin, although it has a considerable amount of systemic absorption after intraperitoneal administration. We herein report a case of severe thrombocytopenia, which was seen during the treatment of a peritonitis attack in a peritoneal dialysis patient. Culture studies revealed methicillin resistant staphylococci as the causative agent and the patient received intraperitoneal vancomycin per sensitivity analysis. Thrombocyte levels dropped abruptly to 3,900/µl after 10 days of vancomycin treatment. Clinical criteria pointed out to vancomycin-related immune thrombocytopenia. Platelet levels did not recover with initial dexamethasone treatment and platelet transfusions. In the meantime, the clinical course was also complicated with intracranial bleeding. Intravenous immunoglobulin treatment was applied and dexamethasone was switched to high-dose methylprednisolone. This latter treatment generated a response and platelet levels gradually increased to normal levels. The patient could be discharged without any sequelae. There have been two previous intraperitoneal vancomycin-related immune thrombocytopenia cases in the literature. Previous cases were reviewed, and the present case was given in comparison with the previous cases.

Diagnosis and Management of Classical Hodgkin Lymphoma During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has brought life to a standstill globally. Intermittent quarantines were applied to control the pandemic and reduce contamination. During the pandemic, patients with hematological malignancies were among the most vulnerable population. Our aim was to compare in terms of demographic data, disease-related factors, symptom-to-diagnosis interval, diagnosis-to-treatment interval , and interim and end-of-treatment response in classical Hodgkin lymphoma patients diagnosed during the pandemic and in the pre-pandemic periods. A total of 90 patients were included, of which 65 and 25 were diagnosed in the 2 years before the pandemic and the 12-month period during the pandemic, respectively. Demographic features were comparable in both groups. Although the percentage of patients with advanced-stage disease was higher during the pandemic (64% vs 53.8%), this difference did not reach statistical significance (P = 0.384). The median symptom-to-diagnosis interval was significantly longer during the pandemic than was observed within the pre-pandemic era (16 weeks vs 8 weeks, P = 0.042). The median diagnosis-to-treatment intervals was similar in both groups (13 days vs 15 days, P = 0.253). In the pre-pandemic and pandemic periods, 85.2% and 72.7% of the patients had complete response at end-of-treatment evaluation, respectively (P = 0.208). We found that symptom-to-diagnosis interval was significantly prolonged during the pandemic. Higher percentage of patients with advanced-stage disease during the pandemic might also be due to this delay, nevertheless, this difference did not reach to a significant difference regarding treatment response in both groups.