Debnath Prasanta, Nair Sujit, Jain Shubham, Udgirkar Suhas, Contractor Qais, Rathi Pravin
TNMC & BYL Nair Charitable Hospital, Mumbai, Maharashtra, India.
Indian J Crit Care Med. 2021 Feb;25(2):228-230. doi: 10.5005/jp-journals-10071-23738.
Thiopurines by their glucocorticoid-sparing property help in maintaining remission for patients with inflammatory bowel disease (IBD), when glucocorticoids are reduced and withdrawn. However, due to bone marrow suppression, it cannot be used in various conditions where it is indicated. A 17-year-old patient presented with pancytopenia with neutropenic sepsis and alopecia after 3 weeks of starting azathioprine for her underlying Crohn's disease. Thiopurine S-methyltransferase (TPMT;*2, *3A, *3C) analysis resulted in a wild-type genotype, whereas homozygous Nudix hydrolase 15 (NUDT 15 C415T) variant was positive. Azathioprine was stopped immediately, and she was started on broad-spectrum antibiotics that led to some clinical improvements initially, but later on, the patient developed intestinal obstruction along with postoperative complications leading to death. In this report, we highlight a case of serious hematological toxicity associated with azathioprine use in a patient with Crohn's disease with homozygous NUDT 15 variant, thus favoring the implementation of a pharmacogenomic approach before starting azathioprine, particularly in the Asian population.
Debnath P, Nair S, Jain S, Udgirkar S, Contractor Q, Rathi P. Thiopurine-induced Myelosuppression with Severe Sepsis in a Patient with Crohn's Disease: A Case Report. Indian J Crit Care Med 2021;25(2):228-230.
The case was presented in abstract form at the American College of Gastroenterology Annual Scientific Meeting, held at San Antonio, TX, USA 2019.
Obtained from patient's relatives.
硫嘌呤类药物具有糖皮质激素节省特性，在糖皮质激素减量和停用期间，有助于炎性肠病（IBD）患者维持缓解状态。然而，由于其骨髓抑制作用，在某些有适应证的情况下无法使用。一名17岁患者，因潜在的克罗恩病开始使用硫唑嘌呤3周后，出现全血细胞减少伴中性粒细胞减少性脓毒症和脱发。硫嘌呤甲基转移酶（TPMT；*2、*3A、*3C）分析显示为野生型基因型，而纯合的Nudix水解酶15（NUDT 15 C415T）变异为阳性。立即停用硫唑嘌呤，并开始使用广谱抗生素，最初病情有所改善，但后来患者出现肠梗阻及术后并发症，最终死亡。在本报告中，我们强调了1例患有纯合NUDT 15变异的克罗恩病患者使用硫唑嘌呤后出现严重血液学毒性的病例，因此建议在开始使用硫唑嘌呤前采用药物基因组学方法，尤其是在亚洲人群中。
Debnath P, Nair S, Jain S, Udgirkar S, Contractor Q, Rathi P. 硫唑嘌呤致克罗恩病患者骨髓抑制伴严重脓毒症：1例报告。《印度重症监护医学杂志》2021；25(2):228 - 230。
该病例以摘要形式在美国胃肠病学会年度科学会议上展示，该会议于2019年在美国得克萨斯州圣安东尼奥市举行。
已获得患者亲属同意。
