Panda Bijoy K, Umarje Siddhi, Diwan Arundhati
1 Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University Erandwane, Pune, Maharashtra, India.
2 Department of General Medicine, Bharati Vidyapeeth Deemed University Medical College and Hospital, Pune, Maharashtra, India.
J Pharm Pract. 2018 Oct;31(5):510-513. doi: 10.1177/0897190017729521. Epub 2017 Sep 6.
Azathioprine, an immunosuppressant which is widely used in the management of the autoimmune neuromuscular disorder. Myasthenia gravis is known to cause myelotoxicity. A 55-year-old male recently diagnosed with myasthenia gravis and chronic kidney disease was put on azathioprine (100 mg/d) along with pyridostigmine and prednisolone. When the treatment was initiated, the hematological reports revealed normal levels of blood count. However, approximately within 3 weeks of continuing the prescribed drugs, the patient was readmitted for complaints of loose watery stools, weakness, and giddiness. Clinical investigations revealed severe pancytopenia, suspecting to be related to azathioprine. The suspected drug (azathioprine) was withdrawn, and the management for pancytopenia was initiated. However, on the second day of hospitalization, the patient underwent cardiac arrest and septic shock which lead to death. Adverse drug reaction assessment revealed a plausible and causal relationship of azathioprine with pancytopenia and other adverse effects seen in this patient.
硫唑嘌呤是一种免疫抑制剂，广泛用于自身免疫性神经肌肉疾病的治疗。重症肌无力已知会导致骨髓毒性。一名55岁男性近期被诊断为重症肌无力和慢性肾脏病，开始使用硫唑嘌呤（100毫克/天），同时服用吡啶斯的明和泼尼松龙。治疗开始时，血液学报告显示血细胞计数水平正常。然而，在继续服用规定药物约3周后，患者因腹泻、虚弱和头晕等症状再次入院。临床检查发现严重全血细胞减少，怀疑与硫唑嘌呤有关。停用可疑药物（硫唑嘌呤），并开始对全血细胞减少进行治疗。然而，在住院第二天，患者发生心脏骤停和感染性休克，最终导致死亡。药物不良反应评估显示，硫唑嘌呤与此患者出现的全血细胞减少及其他不良反应之间存在合理的因果关系。
