硫唑嘌呤相关急性白血病1例报告与文献回顾

Acute leukemia associated with azathioprine:a case report and review of literature

1例78岁男性特发性肺间质纤维化患者,应用泼尼松、硫唑嘌呤及雷公藤总苷联合治疗。给予硫唑嘌呤150 mg/d,共用19个月,总量93 g。2年后,患者出现发热、呼吸困难。入院查血常规：WBC 0.83×109/L,N 0.06,L 0.86,M 0.18~0.39,PLT 74×109/L,Hb 121 g/L;骨髓涂片：有核细胞增生活跃,分类不明细胞占50%,该类细胞呈深灰色,中等偏大,有伪足,胞浆中充满紫红色细小颗粒,未见Auer小体;骨髓活检：增生低下,三系细胞减少;血细胞染色：过氧化物酶呈阴性或弱阳性,碱性磷酸酶90%阳性。入院76 d复查骨髓象：有核细胞增生明显活跃,幼稚单核细胞占56%,三系细胞增生受抑。皮下注射阿糖胞苷200 mg/d,连用2 d。效果不佳,于入院后128 d死亡。

A 78-year-old man with idiopathic pulmonary interstitial fibrosis received combination therapy with prednisone,azathioprine,and tripterygium glycosides.Azathioprine 150 mg/d was given for 19 months and the total dose was 93 g.Two year later,the patient developed fever and dyspnea.On admission,routine blood test revealed following values： WBC count 0.83×109/L,N 0.06,L 0.86,M 0.18~0.39,PLT count 74×109/L,Hb 121 g/L.Bone marrow smear showed marked hyperplasia of nucleated cells with 50% unclassifiable cells which was dark grey and medium-large with pseudopods and small red-pruple particales filling with the cytoplasm without Auer body.Bone marrow biopsy showed hypoplasia and decreases in three cell lineages.Staining of blood cells was negative or weakly positive for peroxidase and 90% positive rate of alkaline phosphatase.On day 76 of admission,bone marrow picture revealed marked hyperplasia of nucleated cells with 56% immature mononuclear and inhibition of three cell lineages on reexamination.A SC cytarabine 200 mg/d was given for 2 days,but this had no obvious effect.On day 128 of admission,he died.