RESUMO
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.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hepatite Autoimune , Doenças Inflamatórias Intestinais , Humanos , Mercaptopurina/efeitos adversos , Mercaptopurina/metabolismo , Hepatite Autoimune/tratamento farmacológico , Purinas/uso terapêutico , Terapia de Substituição Renal , Azatioprina/metabolismo , Azatioprina/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Metiltransferases/metabolismo , Metiltransferases/uso terapêuticoAssuntos
Tratamento Farmacológico da COVID-19 , Cloroquina/análogos & derivados , Cloroquina/efeitos adversos , Cloroquina/farmacocinética , Síndrome do QT Longo/induzido quimicamente , Idoso , Cloroquina/sangue , Cloroquina/uso terapêutico , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/efeitos dos fármacosRESUMO
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.
Assuntos
Púrpura Fulminante/diagnóstico , RNA Ribossômico 16S/genética , Pele/patologia , Síndrome de Stevens-Johnson/diagnóstico , Biópsia/métodos , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Púrpura Fulminante/genética , Análise de Sequência de RNA/métodosRESUMO
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.
