Piperacillin Induced Acute Severe Thrombocytopenia during VV ECMO in COVID19 Pneumonia: Case Report and Review of the Literature

Piperacillin-tazobactam is a frequently used antibiotic that has a broad spectrum of antibacterial activity and a wide safety profile. The development of thrombocytopenia following the use of piperacillin is usually a gradual phenomenon occurring several days following the first exposure, which is usually mild and passed unnoticed However, re-exposure can cause severe rapid thrombocytopenia secondary to pre-existing antibodies. Thrombocytopenia is relatively common during VV ECMO and multifactorial in nature. We present a case of acute severe thrombocytopenia after re-exposure to piperacillin during a prolonged VV ECMO run for COVID 19 respiratory failure leading to diagnostic challenge, after withdrawal of the piperacillin the acute severe thrombocytopenia improved dramatically, also we provide literature review for the similar cases available in the literature. Our case unique in that it had happened in ECMO patient with severe COVID ARDS, and we clinically confirmed that the piperacillin component of TZP is the culprit for the acute severe thrombocytopenia.