Immune Thrombocytopenia Treated with Intravenous Erythromycin

Abstract

Macrolides (MACs) such as clarithromycin (CAM) and erythromycin (EM) have immunomodulatory effects as well as anti-bacterial activity. In consideration of immunomodulatory effects, we report a patient with primary immune thrombocytopenia (ITP) treated with corticosteroids (CSs) combined with MACs. An 84-year-old woman with ITP was admitted to our hospital for further examination of reduced platelet counts. After admission, the patient was diagnosed with exacerbated primary ITP. The patient was successfully treated with intravenous immunoglobulin. However, the patient was unsuccessfully treated with CSs (i.e., prednisolone (PSL) and methyl PSL) combined with CAM. Eltrombopag (ELT), a thrombopoietin-receptor agonist, was successfully added. However, the patient suffered from aspiration pneumonia, making it impossible to administer oral drugs (i.e., PSL, CAM, and ELT). Alternatively, she was successfully treated with intravenous PSL combined with intravenous EM. This case shows that the efficacy of intravenous EM treatment may be higher than that of oral CAM treatment.