23 August 2019 : Case report
Pancytopenia and Septic Infection Caused by Concurrent Use of Allopurinol and Mercaptopurine: A Case Report Illustrating the Importance of Clinical Pharmacist Consultation
Adverse events of drug therapyAlaa A. Alhubaishi1ACE*
Am J Case Rep 2019; 20:1245-1247
BACKGROUND: Pancytopenia is a hematological condition which is characterized by decreases in all three cellular elements: RBC, WBC, and platelets. As a result, patients with pancytopenia are more prone to anemia, infections, and excessive bleeding. Pancytopenia can be caused by medications or drug interactions that suppress the bone marrow. This case report highlights a drug interaction between allopurinol and mercaptopurine which led to pancytopenia and septic infection, resulting in the patient’s death. This could easily have been avoided if a clinical pharmacist had been consulted.
CASE REPORT: A 55-year-old female patient with a past medical history of gout, depression, back pain, and type 2 diabetes was recently diagnosed with ulcerative colitis and was discharged with a new prescription of mercaptopurine. After 2 months of concurrent use of allopurinol and mercaptopurine, she developed infected foot ulcers, which progressed rabidly to sepsis. At the time, her laboratory findings confirmed pancytopenia. Despite treatment, the patient died.
CONCLUSIONS: This case illustrates the importance of consulting a clinical pharmacist in order to avoid such medical error. The dose of mercaptopurine should be reduced to 25% of the recommended dose when it is given concurrently with allopurinol to reduce the risk of pancytopenia. Health care providers should think about the significant role of clinical pharmacy services. In our case, there were no clinical pharmacist involved in the care of this patient, and as a result of such negligence, the patient lost her life.
Keywords: Drug Interactions, 6-mercaptopurine, Pharmacists, Allopurinol, Pancytopenia, Colitis, Ulcerative, Diabetic Foot, Fatal Outcome, gout, Gout Suppressants, Immunosuppressive Agents, Middle Aged, Pharmacy Service, Hospital, Referral and Consultation, Sepsis
19 May 2022 : Case reportBilateral Emphysematous Pyelonephritis Associated with COVID Pneumonia: A Case Report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936370
17 May 2022 : Case reportHigh-Frequency Oscillatory Ventilation for Refractory Hypoxemia in Severe COVID-19 Pneumonia: A Small Case ...
Am J Case Rep In Press; DOI: 10.12659/AJCR.936651
13 May 2022 : Case reportA case of exacerbation of haloperidol-induced rhabdomyolysis following the onset of COVID-19
Am J Case Rep In Press; DOI: 10.12659/AJCR.936589
19 May 2022 : Case reportExtremes of Anemia: The Lowest Hemoglobin Values Probably Ever Reported in the Pediatric Literature Attribu...
Am J Case Rep In Press; DOI: 10.12659/AJCR.936252
19 May 2022 : Case reportAcute Hepatitis with Positive Autoantibodies: A Case of Natalizumab-Induced Early-Onset Liver Injury
Am J Case Rep In Press; DOI: 10.12659/AJCR.936318
19 May 2022 : Case reportSuccessful Percutaneous Fogarty Thrombectomy for Subacute Lower Limb Ischemia Due to Resistant Thrombus in ...
Am J Case Rep In Press; DOI: 10.12659/AJCR.936377
Most Viewed Current Articles
23 Feb 2022 : Case reportPenile Necrosis Associated with Local Intravenous Injection of Cocaine
Am J Case Rep 2022; 23:e935250
17 Feb 2022 : Case reportMyocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of P...
Am J Case Rep 2022; 23:e934399
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406