Purpose. To describe a case of 6-mercaptopurine acute fulminate hepatotoxicity.
Case Summary. A 65-year-old male with adult acute lymphocytic leukemia was receiving mainte nance therapy with 6-mercaptopurine and methotrex ate when he presented with jaundice, nausea, diar rhea, dysuria, right upper quadrant pain, and dark urine. He presented with elevated bilirubin, aspartate aminotransferase, and alanine aminotransferase. The work-up was negative for other causes of liver dam age. His hospital course included antibiotic therapy, vitamin K, and filgrastim. He was discharged without long-term morbidity from the event and had a normal ization of liver enzymes as an outpatient. Methotrex ate maintenance therapy was continued successfully as an outpatient for > 1 year.
Conclusion. 6-Mercaptopurine is not commonly considered as an agent causing acute hepatotoxicity, but should not be ruled out as a causative agent in the setting of concurrent methotrexate therapy. An epi sode of acute hepatotoxicity did not preclude the continued, safe use of methotrexate in this case.
Robert J., Barbier P., Manaster J., Jacobs E.Hepatotoxicity of cytostatic drugs evaluated by liver function tests and appearance of jaundice. Digestion. 1968 ;1:229-232.
2.
Radford JE, Jr, Bums CP, Jones MP, et al. Adult acute lymphoblastic leukemia: results of the Iowa HOP-L protocol. J Clin Oncol.1989;7:58 - 66.
3.
Linker CA, Levitt LJ, O'Donnell M., et al. Improved results of treatment of adult acute lymphoblastic leukemia . Blood.1987;69: 1242-1248.
4.
Glaxo Wellcome Inc. Mercaptopurine package insert. 1995.
5.
Lin RL, Stein RJ, Schaffer MIA Purinethol® (6-mercaptopurine) fatality in a case of prescription negligence: a gas chromatographic determination of 6-mercaptopurine. J Forensic Sci.1982; 27:454 - 460.
6.
Farber S.Summary of experience with 6-mercaptopurine. Ann NY Acad Sci.1954;60:412-414.
7.
Schein PS, Winokur SHImmunosuppressive and cytotoxic chemotherapy: long-term complications . Ann Intern Med.1975;82:84-95.
8.
Gross R., Ben-Shlush A., Scapa E.Hepatotoxicity of 6-mercaptopurine in Crohn's disease. Am J Gastorenterol.1992;87:1885-1886.
9.
Gross R.Hepatotoxicity of 6-mercaptopurine and azathioprine. Mayo Clin Proc.1994;69:498.
10.
Present DH, Meltzer SJ, Krumholz MP, et al. 6-mercaptopurine in the management of inflammatory bowel disease: short- and long-term toxicity. Ann Intern Med.1989;111:641-649.
11.
Bessho F., Kinumaki H., Yokota S., et al. Liver function studies in children with acute lymphocytic leukemia after cessation of therapy. Med Pediatr Oncol. 1994;23:111-115.
