mercaptopurine and Granuloma

Crohn's disease (CD) is a granulomatous systemic disorder of unknown etiology. Obvious pulmonary involvement is exceptional in patients with CD. We report a case of a 38-year-old man who suffered from CD for more than 14 years and was treated with oral steroids for more than 10 years. Surgical excision of parts of the ileum was performed for life-threatening ileal bleeding caused by CD. After acute tapering of oral steroids, pulmonary symptoms and radiologic abnormalities were noted. Lung biopsy through thoracoscopy was performed and revealed signs of chronic inflammation with multiple subepithelial noncaseating and epithelioid granulomas on pathologic examination. Intravenous steroids were required in the initial management of life-threatening pulmonary dysfunction after diagnostic thoracoscopy and led to marked improvement. Tuberculocidal therapy was performed until all microbiological cultures were negative. Oral steroid dosage had slowly been tapered over 1 month. He was discharged with clinical and radiologic improvements. After 36 months, the patient's condition is stable on continued treatment with prednisolone and mesalazine.

Topics: Adult; Angiography; Biopsy, Needle; Combined Modality Therapy; Crohn Disease; Drug Therapy, Combination; Follow-Up Studies; Granuloma; Humans; Ileum; Immunohistochemistry; Laparotomy; Lung Diseases; Male; Mercaptopurine; Prednisolone; Risk Assessment; Severity of Illness Index; Tomography, X-Ray Computed

An 18-year-old male was admitted for his second induction chemotherapy treatment for an acute lymphoblastic leukaemia with cyclophosphamide, cytarabine, and mercaptopurine. He presented with high fever, abdominal pain, non-bloody diarrhoea, portal hypertension and leukopenia. Stool sample analysis, blood cultures and extensive work-up were negative. The only microbiologic evidence was the presence of cytomegalovirus DNA detected by PCR. A profound hypogammaglobulinemia was documented. Pathology material reported non-caseating granulomas in liver, bone marrow, duodenum and colon with negative cytomegalovirus immunostaining. What is your diagnosis?. Un varón de 18 años se internó para recibir el segundo ciclo de inducción por una leucemia linfoblástica aguda con ciclofosfamida, citarabina y mercaptopurina. Desarrolló fiebre alta, dolor abdominal, diarrea no sanguinolenta, hipertensión portal y leucopenia. El análisis de materia fecal, cultivos de sangre y una evaluación exhaustiva fueron negativas. La única evidencia microbiológica fue la detección de ADN de citomegalovirus en sangre por PCR. También se documentó una hipogamaglobulinemia profunda. El material de patología reportó granulomas no caseificantes en hígado, médula ósea, duodeno y colon con inmunohistoquímica negativa para citomegalovirus. ¿Cuál es su diagnóstico?

Topics: Adolescent; Cyclophosphamide; Cytarabine; Fever of Unknown Origin; Granuloma; Humans; Male; Mercaptopurine; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Thirteen patients with Wegener's granulomatosis have been treated with cytotoxic agents. Only one died from the disease whereas two died of infectious complications of therapy and one of heart disease. Seven of the nine survivors are well without medication; one is alive with renal insufficiency and one is in the 5th year of treatment. Cholorambucil was least toxic and should be tried first. Cyclophosphamide was more effective than cholorambucil or azathioprine but, because of side effects, should rarely be used initially. Differentiation of Wegener's granulomatosis from lymphomatiod granumatosis, which it resembles clinically, roentgenologically and pathologically, is important since the latter disease responds differently to cytoxic drug therapy.

Topics: Azathioprine; Cyclophosphamide; Drug Evaluation; Granuloma; Granulomatosis with Polyangiitis; Hodgkin Disease; Humans; Lung Diseases; Mercaptopurine; Prednisone; Prognosis; Remission, Spontaneous

Topics: Animals; Animals, Newborn; Antibodies; Antigens; Cyclophosphamide; Female; Fetus; Granuloma; Hemagglutination Tests; Immunosuppression Therapy; Liver; Lung; Male; Mercaptopurine; Mice; Ovum; Pregnancy; Schistosoma mansoni; Schistosomiasis; Solubility

Topics: Adenine; Animals; Chemical Phenomena; Chemistry; Female; Granuloma; Guanine; Injections, Subcutaneous; Liver Neoplasms; Male; Mercaptopurine; Neoplasms, Experimental; Oxides; Purines; Rats; Xanthines

Topics: Animals; Cricetinae; Granuloma; Mercaptopurine; Methotrexate; Trichinella; Trichinellosis

Topics: Animals; Connective Tissue; Foreign Bodies; Granuloma; Granuloma, Giant Cell; Guinea Pigs; Hydroxyproline; Inflammation; Injections, Intraperitoneal; Leukocyte Count; Mercaptopurine; Pentoses; Pharmaceutical Vehicles; Phospholipids; Polyvinyls; Proteins

Topics: Animals; Connective Tissue; Cortisone; Granuloma; Hypersensitivity, Delayed; Mechlorethamine; Mercaptopurine; Rabbits; Streptococcus