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Fatal myelotoxicity after azathioprine treatment
O Slanar1, P Chalupná, A Novotný
1Clinical Pharmacology Unit, Department of Pharmacology, First Faculty of Medicine Charles University, General Teaching Hospital, Prague, Czech Republic. oslan@lf1.cuni.cz
Abstract:
Azathioprine and 6-mercaptopurine have been used for many years in the treatment of inflammatory bowel disease. Approximately 0.3% of the population are homozygous for variant alleles associated with extremely low thiopurine S-methyltransferase enzyme activity. We describe the case of a young patient with ulcerative colitis, homozygous for TPMT*3A alleles, who suffered fatal azathioprine-induced myelotoxicity after standard dosing with azathioprine. Screening for decreased activity of TPMT in patients prior to azathioprine treatment is advised to minimize the risk of drug-induced toxicity.
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