硫唑嘌呤致克罗恩病患者急性胰腺炎

Acute pancreatitis induced by azathioprine in patient with Crohn＇s disease

1例29岁女性患者因克罗恩病口服泼尼松治疗，初始剂量40 mg/d，3个月后减量至25 mg/d，因病情出现反复，泼尼松恢复初始剂量并加服硫唑嘌呤50 mg/d。23 d后，患者出现持续性右上腹疼痛伴恶心呕吐，实验室检查示WBC 13.4×10^9/L、中性粒细胞0.86、嗜酸粒细胞计数0.41×10^9/L、血清淀粉酶336 U/L、血清脂肪酶1 084 U/L，腹部CT示胰腺尾部渗出伴周围脂肪间隙模糊。考虑为硫唑嘌呤所致急性胰腺炎。停用硫唑嘌呤和泼尼松，禁食、水，并予液体复苏、抑制胰酶分泌、止痛等对症治疗。治疗第8天，患者腹痛基本消失，无恶心呕吐，血清淀粉酶63 U/L，血清脂肪酶 47 U/L。第10天，调整克罗恩病治疗方案为肌内注射甲氨蝶呤25 mg、1次/周，口服泼尼松40 mg、1次/d。随访3个月，患者未再出现上腹持续隐痛和呕吐等症状。

A 29-year-old female patient with Crohn′s disease received prednisone orally. The initial dose was 40 mg daily, then gradually decreased to 25 mg daily after 3 months. Because of recurrence of her illness, the dose prednisone was restored to the initial level and azathioprine （50 mg daily） was added. After 23 days, the patient developed persistent abdominal pain with nausea and vomiting. Laboratory tests showed the following values： white blood cell 13.4×10^9/L, neutrophile granulocyte 86.3%, eosinophil count 0.41×10^9/L, serum amylase 336 U/L, serum lipase 1 084 U/L. The result of abdominal CT showed exudation in pancreas tail, with fuzzy images in surrounding fat spaces. The patient was diagnosed as acute pancreatitis induced by azathioprine. Azathioprine and prednisone were stopped, and the patient received fasting, fluid resuscitation, inhibition of pancreatic secretion, and analgesic. On day 8 of symptomatic treatment, the patient′s abdominal symptom disappeared, without nausea and vomiting. The result of laboratory tests showed serum amylase 63 U/L, serum lipase 47 U/L. On day 10, the treatment of Crohn′s disease was adjusted to intramuscular injection of methotrexate 25 mg once a week, and oral prednisone 40 mg daily. The results of following up for 3 months showed that the patient did not show symptoms of vomiting and persistent pain in the upper abdomen.