Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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/
Corresponding author: Jia Yao, MD, Doctor, Department of Gastroenterology, Shanxi Bethune Hospital, No. 99 Longcheng Street, Xiaodian District, Taiyuan 030012, Shanxi Province, China. 18535118814@163.com
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
Core Tip

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.