Azathioprine-induced Veno-occlusive Hepatotoxicity in a Patient with Myasthenia Gravis.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-01-23 DOI:10.2174/0115748863272041231116104839

Nikhil Dongre, Jayantee Kalita, Usha K Misra

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Abstract

Introduction: Myasthenia gravis (MG) is an autoimmune disorder of post-synaptic neuromuscular junction characterised by fatigable muscle weakness and is treated with prednisolone with or without other immunosuppressants, including azathioprine (AZA). Veno-occlusive hepatotoxicity of AZA is a rare complication in MG.

Case report: We report a 35-year-old man with MG who was treated with pyridostigmine, prednisolone, and AZA for 5 years. He presented with abdominal pain and increased fatiguability for 7 days. His serum bilirubin and liver enzymes were elevated, and ultrasound revealed a dilated hepatic vein and portal vein suggestive of veno-occlusive liver disease. The clinical symptoms, liver functions, and ultrasound of the hepatobiliary system normalized after withdrawal of AZA.

Conclusion: A possibility of AZA veno-occlusive hepatoxicity should be considered in an MG patient if presented with abdominal pain, elevated bilirubin and transaminases and ultrasound showing dilatation of hepatic veins. Physicians should be aware of this complication because this toxicity is reversible following dose reduction or withdrawal of AZA.

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一名重症肌无力患者因硫唑嘌呤引起的静脉闭塞性肝中毒。

简介重症肌无力（MG）是一种突触后神经肌肉接头处的自身免疫性疾病，以易疲劳性肌无力为特征，可使用泼尼松龙或其他免疫抑制剂治疗，包括硫唑嘌呤（AZA）。AZA 的静脉闭塞性肝中毒是 MG 罕见的并发症：我们报告了一名 35 岁的男性 MG 患者，他接受吡啶斯的明、泼尼松龙和 AZA 治疗 5 年。他出现腹痛和乏力症状已有 7 天。他的血清胆红素和肝酶升高，超声检查发现肝静脉和门静脉扩张，提示静脉闭塞性肝病。停用 AZA 后，临床症状、肝功能和肝胆系统超声检查均恢复正常：结论：如果 MG 患者出现腹痛、胆红素和转氨酶升高以及超声显示肝静脉扩张，则应考虑 AZA 静脉闭塞性肝中毒的可能性。医生应注意这种并发症，因为这种毒性在减少剂量或停用 AZA 后是可逆的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.