Azathioprine引起之膽汁淤積性肝臟毒性──病例報告及文獻回顧

Azathioprine Induced Cholestatic Hepatotoxicity － A Case Report and Literature Review

一位77歲的多發性肌炎患者，於接受Azathioprine治療後第45天發生嚴重的膽汁淤積，其膽紅素值高到27mg/dl。這位病患並未使用如酒精，藥物，中草藥，血液製劑，或接受麻醉等任何會造成肝毒性的物品。所有的肝炎病毒標記（HAV, HBV, HCV, EBV, CMV），及自體免疫性肝炎標記（ANA, ASMA, AMiA）也都呈現陰性反應，任何的肝臟外阻塞，也藉由腹部超音波排除掉。在這次事件中也發現，病患血清膽固醇濃度高到704 mg/dl。Azathioprine的主要副作用包括了骨髓抑制，過敏反應合併皮膚疹，發燒及肚子痛，而膽汁淤積性肝毒性則並不常見。在以Azathioprine治療自體免疫疾病時，我們希望這篇報告能提高我們對Azathioprine副作用的警覺。

Severe cholestasis, with total bilirubin level more than 27 mg/dl, occurred 45 days after administration of azathioprine in our 77 -year-old patient of polymyositis. The patient had not taken alcohol, drugs, herbal medicine, blood products, or anesthesia, which may contribute to the hepatotoxicity. The hepatitis markers (HA V, HBV, HCV, EBV, CMV), and autoimmune profiles (ANA, ASMA, AMiA) were all negative. Extrahepatic obstruction was also excluded by abdominal sonography. Extremely high serum cholesterol level, up to 704 mg/dl, was also presented during this episode. The main toxic effects of azathioprine include bone marrow suppression, hypersensitivity reaction with skin rash, pyrexia and abdominal pain, but cholestatic hepatotoxicity is not a common complication. We hope this report will increase our alertness about the adverse reaction of azathioprine when treating autoimmune disease.