Köksal Ali Rıza, Alkim Canan, Altinkaya Engin, Buğdaci Mehmet Sait, Özdoğan Osman, Boğa Salih, Alkim Hüseyin, Sökmen Mehmet
Şişli Etfal Training and Research Hospital, Department of Gastroenterology, İstanbul, Turkey.
Turk J Gastroenterol. 2011 Oct;22(5):537-9. doi: 10.4318/tjg.2011.0409.
A 25-year-old female patient with Crohn's disease had been using azathioprine and metronidazole for an extended period because of recurrent perianal and rectovaginal fistulae. Infliximab was added to the treatment regimen following postoperative recurrence of a rectovaginal fistula. Upon the development of severe neutropenia and thrombocytopenia after the third dose of infliximab, azathioprine and infliximab were stopped. Neutropenia work-up did not reveal any other cause. Neutropenia was ameliorated with use of granulocyte colony-stimulating factor. Treatment was restarted with infliximab alone upon leakage from the rectovaginal fistula with no hematologic toxicity. This case was considered as a serious adverse effect of infliximab and azathioprine combination therapy.
一名25岁患有克罗恩病的女性患者，因复发性肛周和直肠阴道瘘长期使用硫唑嘌呤和甲硝唑。直肠阴道瘘术后复发后，英夫利昔单抗被添加到治疗方案中。在第三次注射英夫利昔单抗后出现严重中性粒细胞减少和血小板减少，硫唑嘌呤和英夫利昔单抗停药。中性粒细胞减少症检查未发现任何其他病因。使用粒细胞集落刺激因子后中性粒细胞减少症得到改善。直肠阴道瘘渗漏且无血液学毒性时，仅重新开始使用英夫利昔单抗治疗。该病例被认为是英夫利昔单抗和硫唑嘌呤联合治疗的严重不良反应。
