Underdiagnosis of drug-induced fever leads to extensive investigation and prolongation of hospitalization, and may lead to multiple unnecessary invasive procedures and a wrong diagnosis. Azathioprine is a widely used ...Underdiagnosis of drug-induced fever leads to extensive investigation and prolongation of hospitalization, and may lead to multiple unnecessary invasive procedures and a wrong diagnosis. Azathioprine is a widely used immunosuppressive drug. We report a case of a 53-year-old female patient diagnosed with autoimmune hepatitis treated with azathioprine, who presented to the emergency room with a 6-wk history of fever and chills without other associated symptoms. Since the patient's fever was of unknown origin, she was hospitalized. All treatment was stopped and an extensive workup to explore the source of fever and chills was performed. Results of chest X-ray, viral, urine, and blood cultures, autoimmune serology, transthoracic and transesophageal echocardiography, and abdominal ultrasound revealed no source of infection. A rechallenge test of azathioprine was performed and the fever and chills returned within a few hours. Azathioprine was established as the definite cause following rechallenge. Fever as an adverse drug reaction is often unrecognized. Azathioprine has been reported to cause druginduced fever in patients with inflammatory bowel disease, rheumatoid arthritis, and sarcoidosis. To the bestof our knowledge there have been no previous reports documenting azathioprine-induced fever in patients with autoimmune hepatitis. The occurrence of fever following the readministration of azathioprine suggests the diagnosis of drug-induced fever, particularly after the exclusion of other causes. A careful rechallenge is recommended to confirm the diagnosis.展开更多
Chronic hepatitis C virus(HCV)infection has been associated with liver cancer and cirrhosis,autoimmune disorders such as thyroiditis and mixed cryoglobulinema,and alterations in immune function and chronic inflammatio...Chronic hepatitis C virus(HCV)infection has been associated with liver cancer and cirrhosis,autoimmune disorders such as thyroiditis and mixed cryoglobulinema,and alterations in immune function and chronic inflammation,both implicated in B cell lymphoproliferative diseases that may progress to non-Hodgkin lymphoma(NHL).HCV bound to B cell surface receptors can induce lymphoproliferation,leading to DNA mutations and/or lower antigen response thresholds.These findings and epidemiological reports suggest an association between HCV infection and NHL.We performed a systematic review of the literature to clarify this potential relationship.We searched the English-language literature utilizing Medline,Embase,Paper First,Web ofScience,Google Scholar,and the Cochrane Database of Systematic Reviews,with search terms broadly defined to capture discussions of HCV and its relationship with NHL and/or lymphoproliferative diseases.References were screened to further identify relevant studies and literature in the basic sciences.A total of 62 reports discussing the relationship between HCV,NHL,and lymphoproliferative diseases were identified.Epidemiological studies suggest that at least a portion of NHL may be etiologically attributable to HCV,particularly in areas with high HCV prevalence.Studies that showed a lack of association between HCV infection and lymphoma may have been influenced by small sample size,short follow-up periods,and database limitations.The association appears strongest with the B-cell lymphomas relative to other lymphoproliferative diseases.Mechanisms by which chronic HCV infection promotes lymphoproliferative disease remains unclear.Lymphomagenesis is a multifactorial process involving genetic,environmental,and infectious factors.HCV most probably have a role in the lymphomagenesis but further study to clarify the association and underlying mechanisms is warranted.展开更多
文摘Underdiagnosis of drug-induced fever leads to extensive investigation and prolongation of hospitalization, and may lead to multiple unnecessary invasive procedures and a wrong diagnosis. Azathioprine is a widely used immunosuppressive drug. We report a case of a 53-year-old female patient diagnosed with autoimmune hepatitis treated with azathioprine, who presented to the emergency room with a 6-wk history of fever and chills without other associated symptoms. Since the patient's fever was of unknown origin, she was hospitalized. All treatment was stopped and an extensive workup to explore the source of fever and chills was performed. Results of chest X-ray, viral, urine, and blood cultures, autoimmune serology, transthoracic and transesophageal echocardiography, and abdominal ultrasound revealed no source of infection. A rechallenge test of azathioprine was performed and the fever and chills returned within a few hours. Azathioprine was established as the definite cause following rechallenge. Fever as an adverse drug reaction is often unrecognized. Azathioprine has been reported to cause druginduced fever in patients with inflammatory bowel disease, rheumatoid arthritis, and sarcoidosis. To the bestof our knowledge there have been no previous reports documenting azathioprine-induced fever in patients with autoimmune hepatitis. The occurrence of fever following the readministration of azathioprine suggests the diagnosis of drug-induced fever, particularly after the exclusion of other causes. A careful rechallenge is recommended to confirm the diagnosis.
文摘Chronic hepatitis C virus(HCV)infection has been associated with liver cancer and cirrhosis,autoimmune disorders such as thyroiditis and mixed cryoglobulinema,and alterations in immune function and chronic inflammation,both implicated in B cell lymphoproliferative diseases that may progress to non-Hodgkin lymphoma(NHL).HCV bound to B cell surface receptors can induce lymphoproliferation,leading to DNA mutations and/or lower antigen response thresholds.These findings and epidemiological reports suggest an association between HCV infection and NHL.We performed a systematic review of the literature to clarify this potential relationship.We searched the English-language literature utilizing Medline,Embase,Paper First,Web ofScience,Google Scholar,and the Cochrane Database of Systematic Reviews,with search terms broadly defined to capture discussions of HCV and its relationship with NHL and/or lymphoproliferative diseases.References were screened to further identify relevant studies and literature in the basic sciences.A total of 62 reports discussing the relationship between HCV,NHL,and lymphoproliferative diseases were identified.Epidemiological studies suggest that at least a portion of NHL may be etiologically attributable to HCV,particularly in areas with high HCV prevalence.Studies that showed a lack of association between HCV infection and lymphoma may have been influenced by small sample size,short follow-up periods,and database limitations.The association appears strongest with the B-cell lymphomas relative to other lymphoproliferative diseases.Mechanisms by which chronic HCV infection promotes lymphoproliferative disease remains unclear.Lymphomagenesis is a multifactorial process involving genetic,environmental,and infectious factors.HCV most probably have a role in the lymphomagenesis but further study to clarify the association and underlying mechanisms is warranted.
