与TPMT常见基因突变无关的硫唑嘌呤不良反应  

Azathioprine induced severe adverse reaction without TPMT common gene mutation

作　　者：吕静[1] 江阳[1] 刘娟娟 李佳佳 LYU Jing;JIANG Yang;LIU Juanjuan;LI Jiajia(Department of Dermatology,Chongqing Hospital of Traditional Chinese Medicine,Chongqing 4000ll,China)

机构地区：[1]重庆市中医院皮肤科,重庆400011

出　　处：《临床皮肤科杂志》2025年第4期231-233,共3页Journal of Clinical Dermatology

摘　　要：报告1例与巯基嘌呤甲基转移酶(TPMT)常见基因突变无关的硫唑嘌呤不良反应。患者男,69岁。全身红斑、水疱、糜烂2年。皮肤科检查:头部、面部、颈部、躯干和腋下散在甲盖至鸡蛋大红斑和糜烂面,表面可见少许黄白色和血性分泌物,尼氏征阳性;口腔黏膜可见大片糜烂面和充血。皮损组织病理检查示表皮内水疱。直接免疫荧光示IgG和C3胞间网状沉积。桥粒芯糖蛋白(Dsg)1和Dsg3均阳性。诊断:寻常型天疱疮。治疗:予系统使用糖皮质激素及口服硫唑嘌呤治疗。患者出现严重骨髓抑制等不良反应,该不良反应与TPMT常见基因突变无关。A case of azathioprine induced severe adverse reaction without TPMT common gene mutation is reported.A 69-year-old male presented with erythema,blisters,and erosion of the whole body for over two years.Dermatological examination showed erythema and erosion of the head,neck,trunk and armpits,with yellow to white,bloody discharge on the surface.The oral mucosa showed a large area of erosion and congestion.Nikolsky sign was positive.Histopathological examination re-vealed intraepidermal blister.Direct immunofluorescence revealed intercellular depositions of IgG and C3.Dsgl and Dsg3 were both positive.A diagnosis of pemphigus vulgaris was made.The patient was treated with a combination of glucocorticoids and azathioprine,resulting in severe bone marrow suppression which was not related to TPMT common gene mutation.

关 键 词：硫唑嘌呤 基因突变 骨髓抑制 脱发 

分 类 号：R969[医药卫生—药理学]