Azathioprine-induced severe bone marrow toxicity - A report of 3 cases
Journal
Dermatologica Sinica
Journal Volume
27
Journal Issue
1
Pages
44-51
Date Issued
2009
Author(s)
Abstract
Dermatologists have been using azathioprine as a "steroid sparing agent" for the treatment of various dermatoses including photodermatoses, immunobullous diseases, psoriasis and eczematous diseases. However, in Taiwan, the currently approved indications of azathioprine include only adjunct therapy of renal transplant, systemic lupus erythematosus, severe rheumatoid arthritis, and leukemia. Owing to the off-label nature of azathiopine use in most dermatological practice, clinical vigilance must be taken. We herein report 3 cases of severe bone marrow toxicity after the use of azathioprine and discuss the pathogenesis and suggestive management of this rare complication. The first patient had prolonged pancytopenia lasting for 3 months despite immediate azathioprine withdrawal and 2 consecutive doses of granulocyte colony-stimulating factor. The full blood count of the other two patients had returned to normal one week after treatment. The result of genotyping of three patients to detect most prevalent mutant allele (TPMT*3C) was negative.
SDGs
Other Subjects
antibiotic agent; antihistaminic agent; azathioprine; corticosteroid; granulocyte colony stimulating factor; prednisolone; valaciclovir; adult; aged; article; atopic dermatitis; blood analysis; bone marrow biopsy; bone marrow suppression; bone marrow toxicity; bullous pemphigoid; case report; disease severity; drug dose increase; drug induced disease; drug withdrawal; dyspnea; febrile neutropenia; fever; genotype; human; immunopathology; jaundice; laboratory test; liver toxicity; male; prurigo; symptomatology; thrombocytopenia; treatment failure
Type
journal article