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1. Leukopenia due to Parvovirus B19 in a Crohn's Disease Patient Using Azathioprine

Author

Bernardina M. Kanis, Nanne K. H. de Boer, Dirk P. van Asseldonk, and Ad A. van Bodegraven

Subjects
Crohn's disease, Leukopenia, Thiopurine methyltransferase, biology, Parvovirus, business.industry, Gastroenterology, Inflammatory Bowel Diseases, Azathioprine, biology.organism_classification, medicine.disease, Immunology, biology.protein, medicine, medicine.symptom, business, medicine.drug
Abstract

Thiopurines such as azathioprine (AZA) and 6-mercaptopurine are frequently used for the treatment of inflammatory bowel diseases. Patients with low or absent thiopurine S-methyltransferase (TPMT) activity, resulting in high 6-thioguanine nucleotide levels, have an increased risk of developing leukopenia. Alternatively, certain viral infections could induce leukopenia. We present the case of an adult Crohn’s disease patient with a parvovirusB19 infection and leukopenia during long-term AZA therapy. The uncomplicated long-term use of adequately-dosed AZA and stable non-toxic metabolite levels could not acknowledge TPMT deficiency as a primary cause of the leukopenia. ParvovirusB19 was assumed to induce the leukopenia by restraining myeloid proliferation. In addition, AZA probably potentiated susceptibility to this viral infection and may have inhibited adequate immunological defense. Leukopenia during thiopurine therapy not explained by TPMT deficiency could be induced by parvovirusB19 infection and compels temporal but not permanent cessation of thiopurine therapy.

Published
2009

2. Contents Vol. 79, 2009

Author

Toshifumi Hibi, Hiroshi Nakase, Kensuke Kubota, Kumiko Saito, Yuriko Minegishi, Gundula Straub, Dieter Jüngst, Berthold Schneider, Nobutaka Fujisawa, Yoshihisa Tsuji, Yasser A. Alderlieste, Yoshiyuki Ito, Hiroshi Ichikawa, Yusuke Sekino, Emanuel Burri, Katsura Mizushima, Yukinao Yamazaki, Michael Neubrand, Dirk P. van Asseldonk, Etsuko Kishimoto, Michiro Otaka, Thomas P. Hüttl, Fritz Spelsberg, Sakae Mikami, Fumiyasu Nakamura, Satoshi Kokura, Ikuhiro Hirata, Masahiro Ohtani, Satoru Saito, Keiko Akimoto, Hédia Benmansour, Atsushi Nakajima, Shigeru Koyama, Hirofumi Hara, Ayako Tomimoto, Osamu Handa, Rupert Althaus, Reginald del Pozo, Toshikazu Yoshikawa, Ulrich Beuers, Izumi Nakagawa, Michael Manz, Takeshi Azuma, Ikumi Yoshida, Lukas Degen, Takuji Kato, Stéphane Nancey, Masahiko Inamori, Tatsushi Omatsu, Erik A.J. Rauws, Tetsuya Okayama, Tsutomu Chiba, Yoshihide Ueda, Stephan R. Vavricka, Masaru Kuriyama, Satoko Adachi, Yoshiaki Ohara, Hidekazu Suzuki, Eisuke Iwasaki, Bram D.J. van den Elzen, Denis Gründel, Kouhei Yamashita, Tomohisa Takagi, Tomohiro Watanabe, Sylvette Claudel, Christoph Beglinger, Natsuko Hayashi, Bernard Flourié, Yuji Naito, Atsushi Nakamura, Tatsuhiro Masaoka, Sabine Roman, Kaori Suzuki, Akiyo Yamakawa, Hiroyuki Suto, Bernardina M. Kanis, Ad A. van Bodegraven, Kimiko Hori, Christoph Jüngst, Tomoyuki Akiyama, Driffa Moussata, Toshihiro Nishizawa, and Nanne K. H. de Boer

Subjects
Gastroenterology
Published
2009

3. Leukopenia due to parvovirus B19 in a Crohn's disease patient using azathioprine

Author

Dirk P, van Asseldonk, Bernardina M, Kanis, Nanne K H, de Boer, and Ad A, van Bodegraven

Subjects
Adult, Crohn Disease, Azathioprine, Parvovirus B19, Human, Erythema Infectiosum, Humans, Female, Leukopenia, Immunosuppressive Agents
Abstract

Thiopurines such as azathioprine (AZA) and 6-mercaptopurine are frequently used for the treatment of inflammatory bowel diseases. Patients with low or absent thiopurine S-methyltransferase (TPMT) activity, resulting in high 6-thioguanine nucleotide levels, have an increased risk of developing leukopenia. Alternatively, certain viral infections could induce leukopenia. We present the case of an adult Crohn's disease patient with a parvovirus B19 infection and leukopenia during long-term AZA therapy. The uncomplicated long-term use of adequately-dosed AZA and stable non-toxic metabolite levels could not acknowledge TPMT deficiency as a primary cause of the leukopenia. parvovirus B19 was assumed to induce the leukopenia by restraining myeloid proliferation. In addition, AZA probably potentiated susceptibility to this viral infection and may have inhibited adequate immunological defense. Leukopenia during thiopurine therapy not explained by TPMT deficiency could be induced by parvovirus B19 infection and compels temporal but not permanent cessation of thiopurine therapy.

Published
2009

4. Subject Index Vol. 79, 2009

Author

Masaru Kuriyama, Bernard Flourié, Yuji Naito, Tatsuhiro Masaoka, Sabine Roman, Yoshihisa Tsuji, Yukinao Yamazaki, Katsura Mizushima, Driffa Moussata, Dirk P. van Asseldonk, Kumiko Saito, Kaori Suzuki, Yusuke Sekino, Toshihiro Nishizawa, Erik A.J. Rauws, Tsutomu Chiba, Nanne K. H. de Boer, Akiyo Yamakawa, Stephan R. Vavricka, Izumi Nakagawa, Hirofumi Hara, Tomohisa Takagi, Tomohiro Watanabe, Christoph Beglinger, Bernardina M. Kanis, Etsuko Kishimoto, Berthold Schneider, Michael Neubrand, Nobutaka Fujisawa, Lukas Degen, Kimiko Hori, Atsushi Nakajima, Gundula Straub, Bram D.J. van den Elzen, Hiroshi Ichikawa, Yasser A. Alderlieste, Emanuel Burri, Ikuhiro Hirata, Toshifumi Hibi, Shigeru Koyama, Tomoyuki Akiyama, Rupert Althaus, Toshikazu Yoshikawa, Masahiro Ohtani, Michiro Otaka, Hiroshi Nakase, Sakae Mikami, Takeshi Azuma, Satoko Adachi, Dieter Jüngst, Reginald del Pozo, Thomas P. Hüttl, Kensuke Kubota, Tatsushi Omatsu, Ayako Tomimoto, Hiroyuki Suto, Yuriko Minegishi, Fumiyasu Nakamura, Fritz Spelsberg, Kouhei Yamashita, Sylvette Claudel, Christoph Jüngst, Eisuke Iwasaki, Ad A. van Bodegraven, Keiko Akimoto, Hédia Benmansour, Ulrich Beuers, Stéphane Nancey, Satoshi Kokura, Masahiko Inamori, Osamu Handa, Michael Manz, Yoshiyuki Ito, Satoru Saito, Ikumi Yoshida, Tetsuya Okayama, Yoshihide Ueda, Hidekazu Suzuki, Atsushi Nakamura, Denis Gründel, Takuji Kato, Natsuko Hayashi, and Yoshiaki Ohara

Subjects
Index (economics), Statistics, Gastroenterology, Subject (documents), Mathematics
Published
2009

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