Journal of Clinical Apheresis 30:58–59 (2015)
Letter to the Editor Thrombotic Thrombocytopenic Purpura Following Terbinafine Therapy Kalman Filanovsky,* Erica Sigler, and Lev Shvidel Department of Hematology, Kaplan Medical Center, Rehovot, affiliated with Hadassah and Hebrew University Medical School, Jerusalem, Israel
To the Editor: Terbinafine is a highly effective antifungal medication, applied mainly in the dermatophyte treatment. The systemic use of terbinafine has been increasing in the past decade. The drug is well tolerated [1] and hematological adverse reactions are very rare [2,3]. Thrombotic thrombocytopenic purpura (TTP) is an uncommon disease, characterized by deficient activity in the von Willebrand (vWF) factor-cleaving protease ADAMTS13, which specifically cleaves the multimeric vWF factor. Deficiency of ADAMTS13 increases the plasma levels of large vWF multimer, which ultimately leads to platelet clumping, consumptive thrombocytopenia, and thrombi formation [4,5]. Development of TTP has been linked occasionally to a certain medication. Herein, we described patient who experienced TTP following treatment with terbinafine. A 34-year-old Jewish man was referred to our hospital with complaints on fever, weakness, and abdominal pain during 3 days before admission. He had a history of schizophrenia and hyperlipidemia and he had received olanzapine, escitalopram, and simvastatin for several years. Two weeks prior to the appearance of the symptoms, treatment with terbinafine in a daily dose of 250 mg was started for onychomycosis. At admission, the physical examination was unremarkable. Laboratory tests revealed WBC 6.8 3 109/l, hemoglobin 8.9 g/dl, reticulocytes count 3.4%, platelet count 15 3 109/l; lactate dehydrogenase (LDH), and creatinine were elevated 2205 IU/l and 1.6 mg/dl, respectively, while the liver enzymes were within the normal range. Urinalysis was unremarkable. The peripheral blood smear showed multiple schistocytes. Coombs test was negative and the coagulation profile was normal. Serologic study for HIV, hepatitis B and C, as well as antinuclear antibodies were negative. Serum ADAMTS-13 activity was markedly decreased