吗替麦考酚酯致水通道蛋白 4 抗体阳性横贯性脊髓炎患者肝损伤。
Mycophenolate mofetil-induced liver injury in a patient with aquaporin-4 antibody positive transverse myelitis.
机构信息
Hepatology, Addenbrooke's Hospital, Cambridge, UK.
Hepatology, Addenbrooke's Hospital, Cambridge, UK
出版信息
BMJ Case Rep. 2020 Dec 22;13(12):e238345. doi: 10.1136/bcr-2020-238345.
Abstract
We present a case of a 49-year-old woman diagnosed with aquaporin-4 antibody-positive transverse myelitis, who developed a significant transaminitis 2 months after commencing mycophenolate mofetil (MMF) as a steroid-sparing agent. No other risk factors were identified, a blood liver panel was negative and liver biopsy showed features compatible with drug-induced liver injury (DILI). MMF was stopped with a corresponding normalisation of serum alanine aminotransferase over the next 2 months. This case highlights MMF as a rare cause of DILI and provides justification for monitoring of liver biochemistry on therapy.
摘要
我们报告了一例 49 岁女性，诊断为水通道蛋白 4 抗体阳性的横贯性脊髓炎，在开始使用吗替麦考酚酯（MMF）作为类固醇保肺剂 2 个月后，出现明显的转氨肝酶升高。未发现其他危险因素，肝功能检查正常，肝活检显示符合药物性肝损伤（DILI）的特征。停用 MMF 后，接下来的 2 个月内血清丙氨酸氨基转移酶恢复正常。该病例强调了 MMF 是导致 DILI 的罕见原因，并证明在治疗过程中监测肝功能是合理的。
相似文献
1
Mycophenolate mofetil-induced liver injury in a patient with aquaporin-4 antibody positive transverse myelitis.吗替麦考酚酯致水通道蛋白 4 抗体阳性横贯性脊髓炎患者肝损伤。
BMJ Case Rep. 2020 Dec 22;13(12):e238345. doi: 10.1136/bcr-2020-238345.
2
Efficacy and Safety of Mycophenolate Mofetil in Patients With Autoimmune Hepatitis and Suboptimal Outcomes After Standard Therapy.霉酚酸酯治疗标准治疗后应答不佳的自身免疫性肝炎患者的疗效和安全性。
Clin Gastroenterol Hepatol. 2018 Feb;16(2):268-277. doi: 10.1016/j.cgh.2017.09.063. Epub 2017 Oct 16.
3
Low-Dose Mycophenolate Mofetil for Treatment of Neuromyelitis Optica Spectrum Disorders: A Prospective Multicenter Study in South China.低剂量吗替麦考酚酯治疗视神经脊髓炎谱系疾病：中国南方的一项前瞻性多中心研究。
Front Immunol. 2018 Sep 11;9:2066. doi: 10.3389/fimmu.2018.02066. eCollection 2018.
4
Quantitative analysis of aquaporin-4 antibody in longitudinally extensive transverse myelitis.纵向广泛横贯性脊髓炎中水通道蛋白4抗体的定量分析
J Neuroimmunol. 2015 Jan 15;278:26-9. doi: 10.1016/j.jneuroim.2014.12.006. Epub 2014 Dec 5.
5
MRI Features of Aquaporin-4 Antibody-Positive Longitudinally Extensive Transverse Myelitis: Insights into the Diagnosis of Neuromyelitis Optica Spectrum Disorders.水通道蛋白 4 抗体阳性的长节段横贯性脊髓炎的 MRI 特征：对视神经脊髓炎谱系疾病诊断的启示。
AJNR Am J Neuroradiol. 2018 Apr;39(4):782-787. doi: 10.3174/ajnr.A5551. Epub 2018 Feb 15.
6
Liver enzyme abnormalities in patients with atopic dermatitis treated with mycophenolate mofetil.接受霉酚酸酯治疗的特应性皮炎患者的肝酶异常
Arch Dermatol. 2006 Jan;142(1):109-10. doi: 10.1001/archderm.142.1.109.
7
Mycophenolate mofetil treatment in patients with autoimmune hepatitis failing standard therapy with prednisolone and azathioprine.霉酚酸酯治疗泼尼松龙和硫唑嘌呤标准治疗失败的自身免疫性肝炎患者。
Dig Liver Dis. 2019 Feb;51(2):253-257. doi: 10.1016/j.dld.2018.10.004. Epub 2018 Oct 12.
8
[Relapsing transverse myelitis with anti-aquaporin 4 seropositivity: possible beneficial effects of ciclosporin].抗水通道蛋白4血清阳性的复发性横贯性脊髓炎：环孢素可能的有益作用
Rinsho Shinkeigaku. 2009 Jan;49(1):48-51. doi: 10.5692/clinicalneurol.49.48.
9
Sites of gastrointestinal lesion induced by mycophenolate mofetil: a comparison with enteric-coated mycophenolate sodium in rats.霉酚酸酯诱导的胃肠道损伤部位：与大鼠肠溶型霉酚酸钠的比较
BMC Pharmacol Toxicol. 2018 Jul 4;19(1):39. doi: 10.1186/s40360-018-0234-1.
10
Corticosteroid-Sparing and Optimization of Mycophenolic Acid Exposure in Liver Transplant Recipients Receiving Mycophenolate Mofetil and Tacrolimus: A Randomized, Multicenter Study.接受霉酚酸酯和他克莫司的肝移植受者中皮质类固醇的减量及霉酚酸暴露的优化：一项随机、多中心研究
Transplantation. 2016 Aug;100(8):1705-13. doi: 10.1097/TP.0000000000001228.
本文引用的文献
1
Mycophenolate sodium-induced hepatotoxicity: The second report?霉酚酸钠诱导的肝毒性：第二篇报告？
Nefrologia (Engl Ed). 2019 Sep-Oct;39(5):561-562. doi: 10.1016/j.nefro.2019.02.009. Epub 2019 May 31.
2
Neuromyelitis optica spectrum disorders.视神经脊髓炎谱系疾病。
Clin Med (Lond). 2019 Mar;19(2):169-176. doi: 10.7861/clinmedicine.19-2-169.
3
Low-Dose Mycophenolate Mofetil for Treatment of Neuromyelitis Optica Spectrum Disorders: A Prospective Multicenter Study in South China.低剂量吗替麦考酚酯治疗视神经脊髓炎谱系疾病：中国南方的一项前瞻性多中心研究。
Front Immunol. 2018 Sep 11;9:2066. doi: 10.3389/fimmu.2018.02066. eCollection 2018.
4
BSR and BHPR guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs.英国风湿病学会（BSR）和英国国家卫生与临床优化研究所（BHPR）关于非生物改善病情抗风湿药处方及监测的指南
Rheumatology (Oxford). 2017 Jun 1;56(6):865-868. doi: 10.1093/rheumatology/kew479.
5
Role of mycophenolate mofetil for the treatment of autoimmune hepatitis-an observational study.霉酚酸酯治疗自身免疫性肝炎的作用——一项观察性研究
J Clin Exp Hepatol. 2014 Sep;4(3):221-5. doi: 10.1016/j.jceh.2014.05.003. Epub 2014 Jun 24.
6
Hepatitis due to mycophenolate mofetil used to treat atopic dermatitis and allergic contact dermatitis.霉酚酸酯所致肝炎用于治疗特应性皮炎和过敏性接触性皮炎。
Dermatitis. 2014 Sep-Oct;25(5):284-5. doi: 10.1097/DER.0000000000000074.
7
Clinical mycophenolic acid monitoring in liver transplant recipients.肝移植受者的临床霉酚酸监测
World J Gastroenterol. 2014 Aug 21;20(31):10715-28. doi: 10.3748/wjg.v20.i31.10715.
8
Transverse myelitis--a review of the presentation, diagnosis, and initial management.横贯性脊髓炎——临床表现、诊断及初始治疗综述
Discov Med. 2013 Oct;16(88):167-77.
9
Evidence-based guideline: clinical evaluation and treatment of transverse myelitis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.循证指南：横贯性脊髓炎的临床评估和治疗：美国神经病学学会治疗学和技术评估小组委员会的报告。
Neurology. 2011 Dec 13;77(24):2128-34. doi: 10.1212/WNL.0b013e31823dc535. Epub 2011 Dec 7.
10
Treatment of neuromyelitis optica with mycophenolate mofetil: retrospective analysis of 24 patients.霉酚酸酯治疗视神经脊髓炎：24例患者的回顾性分析
Arch Neurol. 2009 Sep;66(9):1128-33. doi: 10.1001/archneurol.2009.175.
Zotero 插件