Martínez-Mondragón JD, Torres-Cabrera X, Morales-Pascacio JC, Torres-Cuevas JL, Torres-Escalante JL

Language: Spanish
References: 21
Page: 928-932
PDF size: 229.61 Kb.

ABSTRACT

Background: The spectrum of neuromyelitis optica is an autoimmune and demyelinating disease. Azathioprine decreases relapses and deterioration from this disease. However, it can cause myelotoxicity with life-threatening consequences, like bone marrow aplasia.
Clinical case: A 56-year-old female patient who had an insidious presentation of postrema area syndrome, transverse myelitis and optic neuritis, with negative antiaquaporin 4 antibodies, the diagnosis of seronegative optic neuromyelitis spectrum was made. After acute management, azathioprine was added and 13 days after the first dose patient presented pancytopenia, oral ulcers, hair loss and febrile neutropenia, which led us to rethink the problem, consider alternative diagnoses and adverse effects to treatment.
Conclusions: Due to the severity of myelotoxicity it is advisable to determine the activity of thiopurine methyltransferase, which is not feasible in most hospitals. The present is a clear example that patients and their diseases tend to have a changing course, even though the diagnosis is accurate and the therapeutic prescribed has been adequate, the response to treatment can change the clinical course of the disease that lead us to rethink the problem, so comprehensive and dynamic evaluation is a fundamental part of the daily practice of the clinical doctor.

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