Reactions 1704, p237 - 2 Jun 2018 Hepatotoxicity, aching limbs and exercise intolerance: 2 case reports In a case series, a 21-month-old boy and a 10-year-old girl were described, of whom, the boy developed aching limbs and exercise intolerance while the girl developed hepatic toxicity following treatment with mercaptopurine [6-Mercaptopurine] [routes not stated, not all dosages and durations of treatments to reactions onsets stated]. Patient 2: The boy, who had acute lymphoblastic leukaemia, received mercaptopurine. His dose was gradually increased but at higher doses, he developed symptoms of aching limbs and exercise intolerance. Consequently, he was switched to tioguanine [6-thioguanine] and his muscular symptoms resolved. Patient 3 : The girl, who had acute lymphoblastic leukaemia, received mercaptopurine. Subsequently, she developed recurrent episodes of conjugated hyperbilirubinaemia after one month of initiating mercaptopurine therapy. Four months later, she was hospitalised due to deranged coagulation, hypoglycaemia and hepatic encephalopathy. A liver biopsy revealed hepatocyte ballooning and moderate cholestasis. These findings were consistent with mercaptopurine induced hepatotoxicity. Thereafter, the girl received supportive management and her liver function recovered. Her mercaptopurine therapy was switched to tioguanine [6-thioguinine]. Author comment: "During maintenance 6MP metabolites were persistently subtherapeutic but [Mercaptopurine] dose escalation was limited by symptoms of aching limbs and exercise intolerance on higher doses. Liver biopsy demonstrated hepatocyte ballooning and moderate cholestasis, consistent with [Mercaptopurine] toxicity." Samuelson C, et al. When should we consider 6-thioguanine instead of 6-mercaptopurine in treating childhood acute lymphoblastic leukaemia? A case series and review of the literature. British Journal of Haematology 181 (Suppl. 1): 189-190 (plus poster) abstr. BSH18-EP-061, Apr 2018. Available from: URL: http://doi.org/10.1111/bjh.15226 [abstract] - United Kingdom 803323276 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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