Treatment-associated acute myeloid leukemia in a patient with Crohn's disease on 6-mercaptopurine

✍ Scribed by Koushik K. Das; Ha Thanh Nishino; Andrew T. Chan

• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 150 KB
• Volume: 16
• Category: Article
• ISSN: 1078-0998
• DOI: 10.1002/ibd.21205

✦ Synopsis

To the Editor:

Immunomodulatory therapies such as 6-mercaptopurine (6-MP) and azathioprine provide high remission rates and success in avoiding steroid dependence in patients with inflammatory bowel disease (IBD). However, these treatments are not without adverse effects including leukopenia, liver function test abnormalities, infection, headache, pancreatitis, fever, hair loss, rash as well as more alarming side effects including malignancy. 1 IBD patients treated with 6-MP are estimated to have a 4-fold increased risk of developing lymphoma in comparison to the general population, a complication that may be associated with antitumor necrosis factor therapy as well. In addition to lymphoma, 6-MP therapy has also been linked to rare treatment-associated acute hematopoietic malignancies. This case report illustrates the clinical challenges in diagnosing the rare and ultimately fatal side effect of 6-MP treatment associated acute myeloid leukemia in a patient with Crohn's disease (CD).

A 62-year-old woman with a 20year history of ileal and right colonic CD was recently referred to our hospital with a complaint of frequent bruising. In 2002 the patient developed perianal fistulas and her gastroenterologist initiated therapy with 6-MP. In