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- W1997777254 abstract "Introduction: Azathioprine (AZA) and other immunomodulating drugs are increasingly used in the pediatric IBD-population but also in other autoimmune and inflammatory diseases. Well known side-effects are important to consider. We can anticipate an increase in the frequency of side-effects due to an increasing usage and efforts to individual doseage optimization. EBV-infections are frequently encountered in childhood, often giving rise to transient haematological effects. Thus, an acute EBV-infection in a child on treatment with azathioprine is not an uncommon clinical challange to deal with. The purpose of the study was to highlight the risk of Epstein Barr Virus (EBV) infections in azathioprine (AZA)-treated patients. Methods: We reviewed our patient database to see whether acute tonsillitis caused by an EBV-infection in children on AZA would lead to bone marrow depression. Results: We have recently seen three patients with IBD (age 17–18 years) and EBV. They had been treated with AZA (1.1–1.6 mg/kg/day) for more than 12 months. All had normal laboratory work-up (i.e. hemoglobin, WBC, platelets, hepatic enzymes; AST/ALT) before onset of the infection. All patients had thiopurine methyltransferase (TPMT) activity and thioguanine nucleotide (TGN) concentrations within normal ranges, in two of them tested prior to the infection, and in the third patient after the infection on the same dose of AZA. The three patients presented with signs of tonsillitis and fever. Within 9–24 days after the first signs of infection a neutrophilic granulocytopenia developed (lowest values were 500, 700 and 1.000/mm3, respectively). This was heralded by a thrombocytopenia 4–7 days after the first signs of infection (lowest values were 35.000, 135.000 and 102.000/mm3, respectively). All changed from normal to elevated hepatic enzymes (AST/ALT). Serological testing revealed IgM-positive EBV-infection. AZA was temporarily discontinued. The blood tests were depressed for several weeks, but all recovered 3–6 weeks after the first signs of infection. Conclusion: EBV-infection may have an additive depressing effect on the bone marrow in patients treated with AZA. Early withdrawal of AZA in these situations can prevent serious complications." @default.
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- W1997777254 date "2004-06-01" @default.
- W1997777254 modified "2023-09-26" @default.
- W1997777254 title "P0696 EPSTEIN BARR VIRUS INFECTION IN PATIENTS ON AZATHIOPRINE: AN ADDITIVE TOXIC EFFECT ON THE BONE MARROW" @default.
- W1997777254 doi "https://doi.org/10.1097/00005176-200406001-00820" @default.
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