Zhou XS, Lu YY, Gao YF, Shao W, Yao J. Bone marrow inhibition induced by azathioprine in a patient without mutation in the thiopurine S-methyltransferase pathogenic site: A case report. World J Clin Cases 2021; 9(17): 4230-4237 [PMID: 34141785 DOI: 10.12998/wjcc.v9.i17.4230]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jun 16, 2021; 9(17): 4230-4237 Published online Jun 16, 2021. doi: 10.12998/wjcc.v9.i17.4230
Bone marrow inhibition induced by azathioprine in a patient without mutation in the thiopurine S-methyltransferase pathogenic site: A case report
Xiao-Shuang Zhou, Yuan-Yue Lu, Yan-Fang Gao, Wen Shao, Jia Yao
Xiao-Shuang Zhou, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030012, Shanxi Province, China
Xiao-Shuang Zhou, Yuan-Yue Lu, Yan-Fang Gao, Department of Nephrology, The Affiliated People's Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
Wen Shao, Jia Yao, Department of Gastroenterology, Shanxi Bethune Hospital, Taiyuan 030012, Shanxi Province, China
Author contributions: Zhou XS and Lu YY reviewed the literature and contributed to manuscript drafting; Gao YF and Shao W collected the data and participated in manuscript drafting; Yao J was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: The procedure performed in the study was in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from the patient included in the study.
Conflict-of-interest statement: There are no conflicts of interest or commercial interests to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Received: December 10, 2020 Peer-review started: December 10, 2020 First decision: January 7, 2021 Revised: January 20, 2021 Accepted: March 24, 2021 Article in press: March 24, 2021 Published online: June 16, 2021 Processing time: 166 Days and 18.1 Hours
Abstract
BACKGROUND
Azathioprine (AZA) and its close analog 6-mercaptopurine are thiopurines widely used in the treatment of patients with cancer, organ transplantation, and autoimmune or inflammatory diseases, including systemic lupus erythematosus. Bone marrow inhibition is a common side effect of AZA, and severe bone marrow inhibition is related to decreased thiopurine S-methyltransferase (TPMT) activity.
CASE SUMMARY
We herein report a patient with proliferative lupus nephritis who was using AZA for maintenance therapy, had no common TPMT pathogenic site mutations, and exhibited severe bone marrow inhibition on the 15th day after oral administration.
CONCLUSION
This report alerts physicians to the fact that even though the TPMT gene has no common pathogenic site mutation, severe myelosuppression may also occur.
Core Tip: Thiopurine S-methyltransferase (TPMT) gene polymorphism testing alone cannot fully predict the occurrence of azathioprine (AZA) adverse reactions such as bone marrow inhibition and alopecia. According to the literature mentioned above, nucleoside diphosphate-linked moiety X motif 15 (NUDT 15) and inosine triphosphate pyrophosphatase (ITPA) gene polymorphism tests should also be performed to predict the occurrence of AZA adverse reactions and further guide initial medication. On the other hand, AZA should be used with caution, and whole blood examination and liver and kidney function should be closely monitored during the entire treatment with AZA regardless of the status of TPMT, NUDT 15, and ITPA single nucleotide polymorphisms.
