Many drugs can induce antibodies that are capable of causing severe thrombocytopenia.1,2 Quinine is the oldest recognized cause of this condition, which was first described in the late 19th century.3 Although quinine has been supplanted by other drugs as a treatment for malaria, it continues to be a major cause of drug-induced thrombocytopenia because of its use for the prevention of nocturnal leg cramps.4,5 Because of concern about drug-induced thrombocytopenia and other adverse effects, the Food and Drug Administration banned over-the-counter use of quinine in 1994,6 and recommended against its use even by prescription in 1995.7 Nonetheless, a number of quinine-containing products are still available,8 and adverse reactions continue to be reported.1,2 Quinidine, a structural isomer of quinine, is probably just as immunogenic, but cases of quinidine-related drug-induced thrombocytopenia have waned in recent years as its use for cardiac arrhythmias has declined. When a patient taking any medication, but especially quinine or quinidine, presents with thrombocytopenia and bleeding, it is important that a drug-induced origin be considered, because further exposure to the offending agent can have serious or fatal consequences. As illustrated by the cases reported herein, however, arriving at the correct diagnosis is not always a simple matter.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 21
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.