ABSTRACT
INTRODUCTION: Mercaptopurine, a thiopurine, is used in various disorders of immune regulation, such as autoimmune hepatitis. Thiopurine metabolism is complex with risk for overdosing, especially when metabolism is impaired by liver dysfunction. Hepatotoxicity may be due to mercaptopurine overdose and is often reversible after prompt cessation of the drug. CASE PRESENTATION: Treatment of thiopurine toxicity is mainly supportive and literature on enhanced elimination by renal replacement therapy is ambiguous. CONCLUSION: In this case of thiopurine toxicity, a patient with autoimmune hepatitis presents with abdominal pain, nausea, vomiting, and diarrhea. We show in this case report that renal replacement therapy had no effect on total body clearance of mercaptopurine.
Subject(s)
Drug-Related Side Effects and Adverse Reactions , Hepatitis, Autoimmune , Inflammatory Bowel Diseases , Humans , Mercaptopurine/adverse effects , Mercaptopurine/metabolism , Hepatitis, Autoimmune/drug therapy , Purines/therapeutic use , Renal Replacement Therapy , Azathioprine/metabolism , Azathioprine/therapeutic use , Inflammatory Bowel Diseases/drug therapy , Methyltransferases/metabolism , Methyltransferases/therapeutic useSubject(s)
COVID-19 Drug Treatment , Chloroquine/analogs & derivatives , Chloroquine/adverse effects , Chloroquine/pharmacokinetics , Long QT Syndrome/chemically induced , Aged , Chloroquine/blood , Chloroquine/therapeutic use , Electrocardiography , Female , Humans , Male , Middle Aged , SARS-CoV-2/drug effectsABSTRACT
Both purpura fulminans and toxic epidermal necrolysis (TEN) are rare and life-threatening disorders with a high mortality. We present a case of suspected rapidly progressive, severe pneumococcal sepsis-induced purpura fulminans complicated by multiple organ failure, severe epidermolysis and cutaneous necrosis. We show the diagnostic challenge to differentiate between purpura fulminans and TEN, as the extensive epidermolysis in purpura fulminans may mimic TEN and we highlight the additional value of repeated skin biopsies and 16S rRNA gene sequencing.
Subject(s)
Purpura Fulminans/diagnosis , RNA, Ribosomal, 16S/genetics , Skin/pathology , Stevens-Johnson Syndrome/diagnosis , Biopsy/methods , Diagnosis, Differential , Female , Humans , Middle Aged , Purpura Fulminans/genetics , Sequence Analysis, RNA/methodsABSTRACT
Invasive group A streptococcal infection is a severe disease with high mortality. Invasive group A streptococcal infection may arise after pelvic inflammatory disease. Pelvic inflammatory disease in postmenopausal women is rare. Here, we report a unique case of a postmenopausal woman with fatal invasive group A streptococcal infection due to pelvic inflammatory disease and an extraordinary course of diagnosis.
