来氟米特与低剂量甲氨蝶呤联合塞来昔布致类风湿关节炎患者重度骨髓抑制伴肝肾功能损害

Severe bone marrow suppression and hepatorenal function lesion induced by leflunomide and low dose of methotrexate and celecoxib combination therapy

1例65岁类风湿关节炎男性患者在使用来氟米特(20 mg,po,qd)与甲氨蝶呤(10 mg,po,qw)联合塞来昔布(0.2 g,po,qd)治疗5周后出现口腔溃疡、咳嗽、咳血痰、高热和咽痛。入院后血常规示重度骨髓抑制,胸部CT示双肺炎症,转氨酶、血肌酐、尿素氮均较用药前明显升高。患者使用可疑药物治疗前血常规、肝功能正常,肾功能轻度异常,因此考虑来氟米特与甲氨蝶呤及塞来昔布联用致严重骨髓抑制伴肝、肾功能损害。予停用可疑药物及相关对症治疗,患者血细胞逐渐回升、肺部炎症得到控制,肝、肾功能逐步好转,病情趋于稳定。

A 65- year- old male patient with rheumatoid arthritis developed mouth ulcers, coughing, expectoration with blood, hyperpyrexia and pharyngalgia after receiving 5 weeks of leflunomide （20 mg, po, qd） and methotrexate （10 rag, po, qw） combined with celecoxib （0.2 g, po, qd） therapy. On hospitalization, routine blood test showed severe bone marrow suppression. Computed tomography of the chest showed inflammation in both lungs. Serum transaminase, creatinine and urea nitrogen went up obviously than before. In view of the patient＇s normal blood counts, normal liver function and mild abnormality of renal function before the treatment, so severe bone marrow suppression accompanying hepatorenal function lesion was considered due to leflunomide and low dose of methotrexate and celecoxib. After stopping the suspected agents and implementing symptomatic treatment, the patient＇s blood counts increased gradually, the inflammation in both lungs was controlled, and hepatorenal function was improved with stable condition.