一个罕见的急性甲甲毒性病例导致骨髓抑制
Samreen Khuwaja1, Matthew Lyons2, Beenish Zulfiqar3
1Sam Houston State University, Academic Hospitalist Christus St Elizabeth Hospital, 2830 Calder Ave, Beaumont, Texas 77702, USA.
Case reports in rheumatology
|March 25, 2024
概括
在老年患者中,低剂量的甲状腺素很少会导致严重的骨髓抑制. 这一病例详细介绍了在开始治疗类风湿性关节炎的甲状腺素治疗后不久出现的非典型的泛细胞衰竭.
科学领域:
- 类风湿病学 类风湿病学
- 血液学 血液学 血液学
- 临床毒理学 临床毒理学
背景情况:
- 甲甲酸是炎症性关节炎的基石疾病修饰性抗风湿药物 (DMARD).
- 虽然通常是安全的,但长期使用可能会导致骨髓抑制,尽管低剂量的严重毒性很少见.
研究的目的:
- 报告一种非典型的急性,危及生命的骨髓抑制病例,该病例发生在年长的患者中,该患者开始服用低剂量的甲状腺素.
- 为了确定潜在的风险因素,有助于这种患者的甲状腺素毒性.
- 强调警监测老年患者在甲状腺酸盐治疗中的不良影响的重要性.
主要方法:
- 一个76岁的男性患者患有血清阴性类风湿性关节炎的病例报告.
- 临床表现,实验室发现 (CBC,ESR,CRP,费里丁,甲铁酸盐水平) 和周围血液涂抹分析.
- 干预包括保持甲状腺素,支持性护理,抗生素,叶酸,可纳和可沃林补充剂.
主要成果:
- 患者在开始服用每周15毫克甲状腺的3周内出现了胰腺,口腔和急性损伤.
- 尽管可检测的血清甲铁酸盐水平最小,但在药物停止后,骨髓抑制最初恶化.
- 用leucovorin治疗和支持措施导致血液恢复和症状改善在8天内.
结论:
- 这一案例说明了老年患者中一种罕见但严重的甲状腺酸诱导的骨髓抑制.
- 多种风险因素可能导致了毒性,这强调了需要仔细选择和监测患者的必要性.
- 早期识别和积极管理,包括leucovorin救援,对于在甲醇毒性中取得有利结果至关重要.
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