Farmacovigilanza SIF > Sezioni > Casi clinici > Casi clinici dalla letteratura > Eosinofilia indotta da vancomicina

Eosinofilia indotta da vancomicina

A cura di Alessandra Russo. Specialista in Tossicologia Medica. Messina

 

Caso clinico (1)

Una bimba di 2 mesi venne ricoverata per la comparsa di diarrea e di febbricola (37,7°C).

La frequenza cardiaca era 132 battiti/min; frequenza respiratoria 32 atti/min; pressione sanguigna 85/54 mmHg.

I risultati degli esami di laboratorio erano i seguenti:

  • Leucociti 17 × 109/l (neutrofili 60,2%; eosinofili 1,2%);
  • Emoglobina, 107 g/l;
  • PCR 17 mg/l;
  • ALT 32 U/l;
  • AST 28 U/l.

La bimba era stata sottoposta in precedenza ad intervento chirugico a livello intestinale ed era stata trattata con molti antibiotici per un lungo periodo di tempo.

 

Il giorno del ricovero venne trattata con vancomicina per via orale e metronidazolo per via endovenosa.

Venne osservato un miglioramento della diarrea.

Tuttavia, il quarto giorno di ricovero, i risultati degli esami di laboratorio erano i seguenti:

  • Leucociti 23,27 × 109/l (neutrofili 29,4%; eosinofili 35%);
  • Emoglobina, 101 g/l.

Il settimo giorno di ricovero, i risultati degli esami di laboratorio erano i seguenti:

  • Leucociti 16,59 × 109/l (neutrofili 30%; eosinofili 23,9%);
  • Emoglobina, 101 g/l;
  • ALT 37 U/l;
  • AST 30 U/l.

I test di funzionalità renale erano nel range della norma.

Una volta che i sintomi clinici migliorarono, la bimba venne dimessa dall’ospedale, con la seguente terapia: vancomicina (40 mg/kg/die) e metronidazolo (25 mg BID) per via orale per 1 settimana.

Due settimane dopo la fine della terapia, i risultati degli esami di laboratorio erano i seguenti: leucociti 9,6 × 109/l (neutrofili 42%; eosinofili 2,1%) ed emoglobina, 97 g/l.

 

Le reazioni avverse più spesso osservate nei pazienti trattati con vancomicina includono nefrotossicità, ototossicità e febbre (2).

A seguito dell’esposizione alla vancomicina, è stata anche riportata l’insorgenza di anemia, leucopenia, trombocitopenia e reazioni cutanee (3-6).

Sono stati segnalati anche diversi casi di eosinofilia associata ad uso di vancomicina (7-38).

 

 Bibliografia

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Ultimo aggiornamento: 15 maggio 2023