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Publication
Iatrogenia rara ao alopurinol
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Authors
Advisor(s)
Abstract(s)
Existem raríssimos casos citados de granulomas da medula
óssea por iatrogenia ao alopurinol. Os granulomas são um
achado raro nas biópsias da medula óssea e podem ter várias
etiologias, nomeadamente infeciosas, neoplásicas, autoimunes,
iatrogénicas ou sarcoidose. Na ausência de características
patognomónicas, recorre-se à integração de dados clínicos,
laboratoriais, imagiológicos e histológicos para estabelecer o
diagnóstico. Descrevemos o caso de um caucasiano, 59 anos,
referenciado à consulta de Medicina por gota úrica, tendo sido
medicado com alopurinol e colchicina. Ao longo do seguimento
surgiram anemia e trombocitopenia. Do estudo por mielograma
e biópsia osteomedular salientavam-se “numerosos granulomas
de tipo epitelióide, sem células multinucleadas, sem identifica-
ção de microrganismos PAS pós diástase ou Ziehl-Neelsen, sem
neoplasia, compatível com mielite granulomatosa”. A etiologia
estabelecida foi a de reação de hipersensibilidade ao alopurinol
pelo que foi descontinuado. Repetido o exame um ano depois,
não se observaram granulomas, facto que reforçou a hipótese
diagnóstica.
There are very few case reports of iatrogenic bone marrow granuloma induced by allopurinol. Granulomas are a rare finding on bone marrow biopsies and can have numerous etiologies, namely infectious, neoplastic, autoimmune, drug related or sarcoidosis. In the absence of pathognomonic features, the combination of clinical, laboratorial, image and histological data is essential to establish a diagnosis. We report a case of a 59 year-old Caucasian, referred to Internal Medicine consultation for gout, an medicated with allopurinol and colchicine. Through his follow-up anemia and thrombocytopenia emerged. Myelogram and bone marrow biopsy revealed “numerous epithelioid granulomas, without multinucleated giant cells, without the identification of microorganisms on PAS diastase stain or Ziehl-Neelsen, without neoplastic cells, consistent with a granulomatous myelitis.” The proposed etiology was a drug hypersensitivity reaction to allopurinol so it was discontinued. The exam was repeated a year later and no granulomas were observed, which confirmed the diagnosis.
There are very few case reports of iatrogenic bone marrow granuloma induced by allopurinol. Granulomas are a rare finding on bone marrow biopsies and can have numerous etiologies, namely infectious, neoplastic, autoimmune, drug related or sarcoidosis. In the absence of pathognomonic features, the combination of clinical, laboratorial, image and histological data is essential to establish a diagnosis. We report a case of a 59 year-old Caucasian, referred to Internal Medicine consultation for gout, an medicated with allopurinol and colchicine. Through his follow-up anemia and thrombocytopenia emerged. Myelogram and bone marrow biopsy revealed “numerous epithelioid granulomas, without multinucleated giant cells, without the identification of microorganisms on PAS diastase stain or Ziehl-Neelsen, without neoplastic cells, consistent with a granulomatous myelitis.” The proposed etiology was a drug hypersensitivity reaction to allopurinol so it was discontinued. The exam was repeated a year later and no granulomas were observed, which confirmed the diagnosis.
Description
Keywords
Alopurinol Reacções adversas a medicamentos
Citation
Med Interna. 2015, 22(3) 163-165
Publisher
Sociedade Portuguesa de Medicina Interna