Rehr E L, Swanson K A, Kern J A
Department of Emergency Medicine, Monmouth Medical Center, Long Branch, NJ 07740.
Ann Pharmacother. 1992 Jul-Aug;26(7-8):907-9. doi: 10.1177/106002809202600707.
To report a case of mercaptopurine-induced fever.
A patient with Crohn's disease was treated with mercaptopurine (6-MP) for an exacerbation of his illness. The patient developed fever and chills. After thorough diagnostic examinations and failure to respond to antimicrobial therapy, symptoms were attributed to an allergic-type reaction to 6-MP. The patient defervesced after 6-MP withdrawal. Fever and chills, along with arthralgias, recurred upon rechallenge with a single dose of 6-MP.
Adverse effects attributable to 6-MP therapy in inflammatory bowel disease were reviewed in the literature. Drug-induced fever has been previously reported; however, it is an uncommon adverse effect and is difficult to diagnose. It is also difficult to predict which patients will have the reaction. It is a diagnosis of exclusion requiring a thorough investigation.
Drug-induced fever should be considered when confronted with fever and chills in patients with inflammatory bowel disease being treated with 6-MP. This case report shows the difficulty in differentiating between an infectious process and an adverse reaction to a medication.
报告一例巯嘌呤引起发热的病例。
一名克罗恩病患者因病情加重接受巯嘌呤（6-MP）治疗。患者出现发热和寒战。经过全面的诊断检查且对抗菌治疗无反应后，症状被归因于对6-MP的过敏型反应。停用6-MP后患者体温恢复正常。再次单剂量使用6-MP激发试验时，发热、寒战以及关节痛再次出现。
对文献中关于炎症性肠病患者接受6-MP治疗的不良反应进行了综述。先前已有药物性发热的报道；然而，这是一种罕见的不良反应，且难以诊断。也很难预测哪些患者会出现这种反应。这是一种排除性诊断，需要进行全面调查。
对于接受6-MP治疗的炎症性肠病患者出现发热和寒战时，应考虑药物性发热。本病例报告显示了区分感染性过程和药物不良反应的困难。
