Department of Medicine, School of Medicine, University of Maryland, Baltimore, MD, USA.
Pharmacotherapy. 2010 Jan;30(1):113. doi: 10.1592/phco.30.1.113.
The antimetabolite mercaptopurine is commonly used as part of treatment regimens for acute lymphoblastic leukemia and as treatment for inflammatory bowel diseases. Adverse effects associated with mercaptopurine include myelosuppression, hepatotoxicity, and hyperpigmentation. We describe a 36-year-old man with Philadelphia chromosome-negative pre-B-cell acute lymphoblastic leukemia who experienced a serious mercaptopurine-induced hypersensitivity reaction requiring prolonged hospitalization and extensive laboratory testing and imaging. He was treated with a multiagent chemotherapy regimen. Mercaptopurine 60 mg/m(2)/day orally was started as part of his third course of chemotherapy. On day 9 of mercaptopurine therapy, the patient developed persistent fevers, skaking chills, and rigors that persisted in the absence of documented infection, consistent with drug fever. All symptoms and signs resolved after discontinuation of mercaptopurine. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship between the patient's development of fever and mercaptopurine therapy. Mercaptopurine-induced fever has been reported in patients with inflammatory bowel diseases, but this case report is the first, to our knowledge, in a patient with acute lymphoblastic leukemia. Health care professionals should be aware of the possible development of fever as a hypersensitivity reaction in patients with acute lymphoblastic leukemia treated with mercaptopurine.
抗代谢物巯嘌呤常用于治疗急性淋巴细胞白血病的治疗方案中，也用于治疗炎症性肠病。与巯嘌呤相关的不良反应包括骨髓抑制、肝毒性和皮肤色素沉着。我们描述了一位 36 岁的费城染色体阴性前 B 细胞急性淋巴细胞白血病患者，他经历了严重的巯嘌呤诱导的过敏反应，需要长时间住院治疗，并进行了广泛的实验室检查和影像学检查。他接受了多药化疗方案治疗。在第三次化疗中，开始给予患者 60mg/m(2)/天的巯嘌呤口服治疗。在巯嘌呤治疗的第 9 天，患者出现持续发热、寒战和肌阵挛，尽管没有记录到感染，但仍符合药物热。在停用巯嘌呤后，所有症状和体征均消退。使用 Naranjo 药物不良反应概率量表表明，患者发热与巯嘌呤治疗之间可能存在关联。已有报道称，炎症性肠病患者会出现巯嘌呤诱导的发热，但据我们所知，这是首例在急性淋巴细胞白血病患者中出现的病例报告。医护人员应意识到接受巯嘌呤治疗的急性淋巴细胞白血病患者可能会出现发热作为过敏反应。
