Successful off-label use of eltrombopag in a case of leishmaniasis complicated by severe treatment-refractory thrombocytopenia

• Autores: Joaquín Borrás Blasco, Alejandro González Álvarez, Patricia Gimeno Borja, M.D. Elvira Casterá Melchor, A. Belda Mira
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 18, Nº. 1, 2016, pág. 11
• Idioma: inglés
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• Resumen

  • Objective. To report the successful off-label use of eltrombopag, in a case of refractory leishmaniasis related severe thrombocytopenia grade 3.

    Case report. A 31-year-old Spanish female presented with more than oneweek history of febrile syndrome. The patient referred weight loss and general asthenia during last five previous months. Abdominal examination showed hepatomegaly and splenomegaly with symptoms of abdominal pain and secondary purpura petechial in lower extremities. Initial platelet count showed a value of 84×10⁹/L and a bone marrow biopsy revealed the presence of extracellular forms (promastigotes) and Leishmania amastigotes into monocytes and macrophages.

    After two weeks, she developed a depression of three lines cell linages with a new platelet count of 38×10⁹/L. The patient did not receive any platelet transfusions. Eltrombopag was used as an off-label drug in the severe episode of thrombocytopenia and her platelets count returned to normal level (140×10⁹/L) with five doses.

    Conclusions. Eltrombopag off-label use could be justified in certain situations. However, there is no evidence of the use of this drug in the treatment of thrombocytopenia secondary to infection with Leishmania spp, which would require more data for its continuous use