Severe Late-Onset Drug-Induced Immune Thrombocytopenia Following IFN β-1a Treatment: A Case Report of a 52-Year-Old Woman with Relapse-Remitting Multiple Sclerosis

Table 1

Left panel: differential diagnosis of thrombocytopenia. Middle panel: drugs with drug-platelet antibodies involved in drug-induced thrombocytopenia (Adapted from https://www.ouhsc.edu/platelets). Right panel: mechanisms of immune-mediated drug-induced thrombocytopenia (adapted from 10).

Differential diagnosis of thrombocytopenia	Drugs implicated in drug-induced thrombocytopenia (immune-mediated platelet destruction)	Mechanisms of drug-dependent antibodies
(i) Pseudothrombocytopenia; (ii) Medications (immune-mediated platelet destruction and non-immune suppression of platelet production); (iii) Herbal preparation, food (walnut and sesame seeds), and beverages (tonic water and cranberry juice); (iv) Infectious diseases (CMV, EBV, Parvovirus B19, HIV, VHB, VHC, H. pylori, M. tuberculosis, and M. pneumoniae); (v) Vaccines (measles, influenza, and VHB); (vi) Hematological and solid cancers; (vii) Hemolysis and DIC; (viii) Hypersplenism; (ix) Autoimmune diseases (SLE, scleroderma, Sjögren's disease, and MCTD); (x) Vitamin deficiencies (B9 and B12) or copper deficiency; (xi) Thrombotic microangiopathy (TTP and HSU); (xii) Iodinated contrast product	(i) NSAIDs (naproxen, diclofenac, and ibuprofen); (ii) Antibiotics (rifampicin, penicillins, trimethoprim-sulfamethoxazole, and vancomycin); (iii) Antiepileptics (carbamazepine, phenytoin, and valproic acid); (iv) Quinine and quinidine; (v) H2-receptor antagonists (ranitidine and cimetidine); (vi) Chlorothiazide and hydrochlorthiazide; (vii) Chemotherapy (oxaliplatin and gold); (viii) Glycoprotein IIb/IIIa receptor antagonists (tirofiban, abciximab, and eptifibatide); (ix) Interferon α	(i) Classic drug-dependent antibodies targeted to neoepitope created by noncovalent binding of the drug to platelet glycoproteins; (ii) Hapten-induced antibodies created by covalent binding of drug to platelet proteins; (iii) Specific fiban- and Fab-binding antibodies (glycoprotein IIb/IIIa receptor antagonists); (iv) Autoantibody production in response to a given drug (gold and alemtuzumab); (v) Platelet-localizing immune complexes leading to their activation and clearance

Abbreviations: CMV: cytomegalovirus; DIC: disseminated intravascular coagulation; EBV: Epstein–Barr virus; HIV: human immunodeficiency virus; HUS: hemolytic uremic syndrome; MCTD: mixed connective tissue disease; NSAIDs: Nonsteroidal anti-inflammatory drugs; SLE: systemic lupus erythematosus; TTP: thrombotic thrombocytopenic purpura; VHB/VHC: viral hepatitis B/C.