mercaptopurine and Exanthema

6-mercaptopurine is a mainstay of acute lymphoblastic leukemia treatment. It has a narrow therapeutic window, dictated by its metabolite, thioguanine and 6-methylmercaptopurine. Skin manifestations usually consist of mild facial rash or hypersensitivity exanthems. We report a child who developed a painful acral rash and mucositis while undergoing maintenance therapy for B-cell acute lymphoblastic leukemia without infectious or known drug etiology. Thiopurine metabolites were skewed toward 6-methylmercaptopurine. Two weeks after allopurinol was added and 6-mercaptopurine (6-MP) dose adjusted, the cutaneous manifestations and other constitutional symptoms resolved. We posit that the rash was because of 6-MP toxicity related to skewed metabolism, adding to the growing list of toxicity related to altered 6-MP metabolism.

Topics: Allopurinol; Burkitt Lymphoma; Child; Exanthema; Humans; Mercaptopurine; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Thioguanine

Topics: Antibodies, Monoclonal; Crohn Disease; Exanthema; Female; Gastrointestinal Agents; Humans; Infliximab; Mercaptopurine; Methotrexate; Middle Aged; Peripheral Nervous System Diseases; Steroids; Treatment Outcome; Tumor Necrosis Factor-alpha

Topics: Antimetabolites, Antineoplastic; Child; Exanthema; Excipients; Humans; Hypersensitivity; Male; Mercaptopurine; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Starch; Tablets

5-Aminosalicylic acid (5-ASA)-containing drugs are the mainstay of therapy in inflammatory bowel disease, but adverse reactions to these medications are relatively common. Because there may be a lack of cross-reactivity among the various 5-ASA formulations, treatment with alternative preparations is sometimes possible even after an apparent allergic reaction to a 5-ASA product.. To describe a patient with a possible allergy to 2 different 5-ASA drugs who tolerated a third.. A 27-year-old man with Crohn disease developed a rash while taking mesalamine (Pentasa and Asacol). Treatment with 5-ASA products was discontinued, and 6-mercaptopurine and prednisone were prescribed. He then experienced multiorgan failure secondary to herpes simplex infection, which required discontinuation of the immunosuppressive therapy. After recovery from the acute infection, he underwent successful graded challenge with balsalazide.. The patient continued treatment with balsalazide for 9 months, with good control of his inflammatory bowel disease and no adverse effects.. Adverse reactions to 1 or more 5-ASA medications do not necessarily preclude the use of others in the same class. A treatment algorithm for patients with adverse reactions to 5-ASA is outlined based on the case report and review of the literature.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Crohn Disease; Cross Reactions; Drug Hypersensitivity; Exanthema; Herpes Simplex; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Mesalamine; Phenylhydrazines; Prednisone