mercaptopurine and Gastrointestinal-Hemorrhage

Amyloidosis is characterized by a deposition of insoluble fibrils in various organs and tissues. Amyloid deposition, in the gastrointestinal track, provokes a dysfunction of the organ, due to an accumulation of fibrils, and causes a variety of clinical symptoms and endoscopic findings. Primary amyloidosis in the gastrointestinal tract is rarely reported in Korea. We experienced a case of recurrent intestinal bleeding, in a 59-year-old female patient with primary amyloidosis. A colonoscopy revealed the presence of multiple large circular ulcers. In the entire colon, diffuse nodular lesions with edema and bleeding were found. A colonoscopic biopsy established the diagnosis of amyloidosis, to the exclusion of other disease components. We concluded that the patient had localized amyloidosis. Though a definitive therapeutic strategy has not been established for localized gastrointestinal amyloidosis, the patient has been successfully treated with a high-dose of steroids and azathioprine.

Topics: Amyloidosis; Antimetabolites; Colon; Colonoscopy; Female; Gastrointestinal Hemorrhage; Humans; Immunoglobulin Light-chain Amyloidosis; Mercaptopurine; Middle Aged; Steroids; Tomography, X-Ray Computed

Acute severe lower gastrointestinal bleeding in Crohn's disease is uncommon, but is a diagnostic and therapeutic challenge. We aimed to identify risk factors for acute lower gastrointestinal bleeding in patients with Crohn's disease and assess the cumulative probability of rebleeding in relation to therapeutic modality.. We retrospectively reviewed the medical records of 70 Crohn's patients (4.0%) with acute severe lower gastrointestinal bleeding and compared these with matched 140 Crohn's patients without bleeding.. The cumulative probability of bleeding after diagnosis of Crohn's disease was 1.7%, 3.6%, 6.5%, and 10.3% after 1, 5, 10, and 20 years respectively. At presentation, the median haemoglobin concentration was 8.4g/dL (range, 4.7-11.6g/dL). Use of azathioprine/6-mercaptopurine decreased the risk of lower gastrointestinal bleeding (OR: 0.525, 95% CI: 0.304-0.906, p=0.021). Bleeding recurred in 29 patients (41.4%) after a median time of 3.2 months (range, 15 days-94.7 months). One out of eleven patients treated with infliximab rebled. The cumulative probability of rebleeding tended to be lower in patients treated with infliximab than in those receiving other treatments (p=0.076).. Azathioprine/6-mercaptopurine may reduce the risk of acute severe lower gastrointestinal bleeding. The rebleeding is common, but infliximab may decrease rebleeding.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Monoclonal; Asian People; Azathioprine; Blood Transfusion; Case-Control Studies; Colonic Diseases; Crohn Disease; Embolization, Therapeutic; Female; Gastrointestinal Hemorrhage; Hemoglobins; Hemostasis, Endoscopic; Humans; Ileal Diseases; Immunosuppressive Agents; Infliximab; Kaplan-Meier Estimate; Male; Mercaptopurine; Middle Aged; Recurrence; Republic of Korea; Retrospective Studies; Risk Factors; Young Adult

Topics: Anecdotes as Topic; Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Colitis, Ulcerative; Diagnostic Errors; Disease Progression; Female; Gastrointestinal Hemorrhage; Hospitalization; Humans; Immunosuppressive Agents; Mercaptopurine; Mesalamine; Patient Acceptance of Health Care; Recurrence; Shame; Students; Treatment Outcome; Young Adult

Immunomodulator therapy with thiopurine analogues azathioprine or 6-mercaptopurine is commonly prescribed for the treatment of organ transplantation, inflammatory bowel disease, autoimmune diseases and malignancies. Hepatotoxicity due to thiopurine analogues usually presents as an increase in serum transaminase levels. Toxicity is usually not severe, and a dose reduction is effective in most patients. Nodular regenerative hyperplasia (NRH) is a very rare but potentially severe complication of thiopurine-containing therapy. NRH is often asymptomatic, neither biochemical nor molecular markers are indicative for NRH. The suspicion rises when there are clinical symptoms of portal hypertension or increases in transaminases levels orthrombocytopenia. Liver biopsy is essential for definitive diagnosis. This is a case report of a 40-year-old male patient with Crohn's disease who developed increased serum levels of liver enzymes and thrombocytopenia following the administration of thiopurine. Although treatment with thiopurine was discontinued, he has further progressed and presented with acute variceal bleeding due to portal hypertension. The diagnosis of nodular regenerative hyperplasia was proven by a liver biopsy. In conclusion, NRH is a very rare but potentially severe complication of thiopurine-containing immunosuppressive therapy for IBD.

Topics: Adult; Chemical and Drug Induced Liver Injury; Crohn Disease; Disease Progression; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Hyperplasia; Hypertension, Portal; Immunosuppressive Agents; Male; Mercaptopurine; Thrombocytopenia

A 59-year-old man was referred to our hospital because of pancytopenia. Peripheral blood examination showed a WBC of 1,500/microliters with 2% blasts, Hb 8.1 g/dl and a platelet count of 4.1 x 10(4)/microliters. A bone marrow aspiration revealed hyperplasia with proliferation of blasts (15.7%) and myelodysplasia. Chromosome analysis revealed multiple aberrations, including -5, -7, +8. The patient was given a diagnosis of refractory anemia with excess of blasts (RAEB) and treated with combination chemotherapy. Agranulocytosis and high fever remained after chemotherapy, and abdominal pain and diarrhea developed. An abdominal X-ray film and computed tomography scan demonstrated dilated small bowel, thickness of the bowel wall, and ascites. A diagnosis of neutropenic enterocolitis was given. During the WBC recovery period from nadir, massive hematochezia developed in the patient. Angiography detected the leakage of contrast medium from a peripheral region of the first jejunal artery into the jejunal lumen. A partial resection of the jejunum was thus performed, and a histological examination revealed the presence of irregularly dilated blood vessels in the submucosal layer. These findings were consistent with the features of angiodysplasia, and indicate that angiodysplasia should be considered one cause of intestinal hemorrhage in elderly patients during intensive chemotherapy.

Topics: Anemia, Refractory, with Excess of Blasts; Angiodysplasia; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Drug Therapy, Combination; Emergencies; Enterocolitis; Gastrointestinal Hemorrhage; Humans; Idarubicin; Jejunal Diseases; Male; Mercaptopurine; Middle Aged; Neutropenia; Prednisolone; Vincristine

Topics: Aged; Animals; Antibodies; Antibody Formation; Anticoagulants; Azathioprine; Blood Transfusion; Cattle; Child; Cyclophosphamide; Elbow; Factor VIII; Female; Gastrointestinal Hemorrhage; Hemarthrosis; Hematoma; Hemophilia A; Humans; Immunosuppressive Agents; Knee; Male; Mercaptopurine; Methotrexate; Middle Aged; Penicillin G Benzathine; Prednisone; Serum Sickness; Swine; Thigh

Topics: Adolescent; Adult; Aged; Allopurinol; Anaphylaxis; Asparaginase; Blood Coagulation Disorders; Cytarabine; Daunorubicin; Drug Hypersensitivity; Female; Fever; Gastrointestinal Hemorrhage; Hallucinations; Humans; Hyperglycemia; Injections, Intravenous; Jaundice; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Liver; Male; Mercaptopurine; Methotrexate; Middle Aged; Oral Hemorrhage; Prednisone; Thioguanine; Uremia; Vincristine; Vomiting

Topics: Antimetabolites; Biopsy; Chemical and Drug Induced Liver Injury; Child; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Hypersplenism; Hypertension, Portal; Leukemia, Lymphoid; Liver; Liver Diseases; Mercaptopurine

Topics: Bronchospirometry; Dogs; Gastrointestinal Hemorrhage; Imidazoles; Lung; Lung Abscess; Mediastinal Emphysema; Mercaptopurine; Methotrexate; Pneumonia; Radiography, Thoracic; Research; Transplantation; Transplantation Immunology; Transplantation, Homologous

Topics: Blood Cell Count; Bone Marrow Examination; Candidiasis; Erythema Nodosum; Female; Gastrointestinal Hemorrhage; Humans; Leukemia; Mercaptopurine; Middle Aged; Prednisone; Sepsis