From Epistaxis to a Platelet Count of Four: A Rare Presentation of Teicoplanin-Induced Thrombocytopenia

Teicoplanin is a glycopeptide antibiotic used for serious Gram-positive infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA) and resistant Enterococcus species. While generally safe, it may rarely lead to haematological complications such as drug-induced immune thrombocytopenia (DITP), a potentially life-threatening disorder caused by immune-mediated platelet destruction. We report a case of severe symptomatic thrombocytopenia occurring 10 days after starting teicoplanin therapy in an elderly patient with a diabetic foot infection. Comprehensive clinical and laboratory assessments excluded alternative causes. Teicoplanin was stopped, and the patient received a single dose of intravenous immunoglobulin (IVIG), which led to gradual platelet recovery and cessation of bleeding. This report underscores the importance of routine blood count monitoring, early recognition of thrombocytopenia, and timely discontinuation of teicoplanin to prevent major bleeding. It also highlights the necessity of further studies to clarify the mechanisms of teicoplanin-induced thrombocytopenia (TIT), improve drug-specific antibody testing, and define the role of IVIG in treatment.