Azathioprine/prednisolone/tacrolimus

Azathioprine/prednisolone/tacrolimus Reactions 1704, p59 - 2 Jun 2018 Non-neutropaenic typhlitis: case report A 63-year-old woman developed non-neutropaenic typhlitis during immunosuppressive treatment with azathioprine, prednisolone and tacrolimus [time to reaction onset not stated]. The woman presented to the emergency department after two episodes of collapse, septic shock with acute renal failure, peritonitis and an elevated lactate level. On presentation, examination showed generalised abdominal tenderness with peritonism. Further investigation revealed the following: WBC count 27.1, RBC 3.79, haemoglobin 113, mean cell volume 91.0, haematocrit 0.345, mean corpuscular haemoglobin 29.8, platelets 267, neutrophils 21, lymphocyte 3.7, eosinophil 0, basophil 0.1, monocyte 2.4 and nucleated RBC 0 [units not stated]. Her medical history was significant for a primary sclerosing cholangitis with a liver transplant in 2010. Her immunosuppressive regimen included azathioprine, prednisolone and tacrolimus [routes and dosages not stated]. The long term use of prednisolone had led to led to hypoadrenalism. On the basis of her presentating sings, a presumptive diagnosis of ischaemic bowel was made. In view of her renal failure, a non-contrast CT scan was performed, which showed evidence of intramural gas in relation to loops of small bowel located in the left iliac fossa with marked mesenteric and portal venous gas. Additionally, marked pelvic and abdominal vascular calcification including the superior mesenteric artery and some of its proximal branches was seen. Bowel perforation, free gas or fluid within the abdomen were not seen. The woman received treatment with unspecified broad spectrum antibiotics and required inotropic support as well as fluid resuscitation. She then underwent laparotomy. The findings of laparotomy revealed dense adhesions but with normal healthy small bowel, which was peristalsing. There was no areas of bowel wall necrosis or turbid free fluid. She was transferred to the ICU, where she was treated with unspecified IV antibiotics and managed a complete clinical recovery. No infectious aetiology was identified after several investigations. Tacrolimus, which was held on admission, was stared again. Subsequently, she was discharged home on the postoperative day 12. Author comment: "[T]his is the first published case of non-neutropaenic typhlitis in an immunosuppressed patient with tacrolimus thought to be a significant causative factor." Leiberman D, et al. Unique case of non-neutropaenic typhlitis in an immunosuppressed liver transplant patient. BMJ Case Reports 2018: 224470, 25 Apr 2018. Available from: URL: http://doi.org/10.1136/bcr-2018-224470 - United Kingdom 803323081 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Reactions Weekly Springer Journals

Azathioprine/prednisolone/tacrolimus

Reactions Weekly , Volume 1704 (1) – Jun 2, 2018
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Publisher
Springer International Publishing
Copyright
Copyright © 2018 by Springer International Publishing AG, part of Springer Nature
Subject
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
ISSN
0114-9954
eISSN
1179-2051
D.O.I.
10.1007/s40278-018-46702-x
Publisher site
See Article on Publisher Site

Abstract

Reactions 1704, p59 - 2 Jun 2018 Non-neutropaenic typhlitis: case report A 63-year-old woman developed non-neutropaenic typhlitis during immunosuppressive treatment with azathioprine, prednisolone and tacrolimus [time to reaction onset not stated]. The woman presented to the emergency department after two episodes of collapse, septic shock with acute renal failure, peritonitis and an elevated lactate level. On presentation, examination showed generalised abdominal tenderness with peritonism. Further investigation revealed the following: WBC count 27.1, RBC 3.79, haemoglobin 113, mean cell volume 91.0, haematocrit 0.345, mean corpuscular haemoglobin 29.8, platelets 267, neutrophils 21, lymphocyte 3.7, eosinophil 0, basophil 0.1, monocyte 2.4 and nucleated RBC 0 [units not stated]. Her medical history was significant for a primary sclerosing cholangitis with a liver transplant in 2010. Her immunosuppressive regimen included azathioprine, prednisolone and tacrolimus [routes and dosages not stated]. The long term use of prednisolone had led to led to hypoadrenalism. On the basis of her presentating sings, a presumptive diagnosis of ischaemic bowel was made. In view of her renal failure, a non-contrast CT scan was performed, which showed evidence of intramural gas in relation to loops of small bowel located in the left iliac fossa with marked mesenteric and portal venous gas. Additionally, marked pelvic and abdominal vascular calcification including the superior mesenteric artery and some of its proximal branches was seen. Bowel perforation, free gas or fluid within the abdomen were not seen. The woman received treatment with unspecified broad spectrum antibiotics and required inotropic support as well as fluid resuscitation. She then underwent laparotomy. The findings of laparotomy revealed dense adhesions but with normal healthy small bowel, which was peristalsing. There was no areas of bowel wall necrosis or turbid free fluid. She was transferred to the ICU, where she was treated with unspecified IV antibiotics and managed a complete clinical recovery. No infectious aetiology was identified after several investigations. Tacrolimus, which was held on admission, was stared again. Subsequently, she was discharged home on the postoperative day 12. Author comment: "[T]his is the first published case of non-neutropaenic typhlitis in an immunosuppressed patient with tacrolimus thought to be a significant causative factor." Leiberman D, et al. Unique case of non-neutropaenic typhlitis in an immunosuppressed liver transplant patient. BMJ Case Reports 2018: 224470, 25 Apr 2018. Available from: URL: http://doi.org/10.1136/bcr-2018-224470 - United Kingdom 803323081 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704

Journal

Reactions WeeklySpringer Journals

Published: Jun 2, 2018

References

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