A Case of Pancytopenia with Many Possible Causes: How Do You Tell Which is the Right One?
Systemic lupus erythematosus (SLE) often presents with cytopenia(s); however, pancytopenia is found less commonly, requiring the consideration of possible aetiologies other than the primary disease. The authors describe the case of a female patient with a recent diagnosis of SLE admitted through the...
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doaj-1ea3b6e5838843508b9a87c13f0c7ce52020-11-24T21:17:00ZengSMC MEDIA SRLEuropean Journal of Case Reports in Internal Medicine2284-25942019-01-0110.12890/2019_0010121012A Case of Pancytopenia with Many Possible Causes: How Do You Tell Which is the Right One?Priscila Diaz0Mariana Abreu Vieira1António Carneiro2Natália Fernandes3Department of Internal Medicine, Hospital de Cascais, Cascais, PortugalDepartment of Internal Medicine, Hospital de Cascais, Cascais, PortugalDepartment of Internal Medicine, Hospital de Cascais, Cascais, PortugalDepartment of Internal Medicine, Hospital de Cascais, Cascais, PortugalSystemic lupus erythematosus (SLE) often presents with cytopenia(s); however, pancytopenia is found less commonly, requiring the consideration of possible aetiologies other than the primary disease. The authors describe the case of a female patient with a recent diagnosis of SLE admitted through the Emergency Department with fever of unknown origin and severe pancytopenia. She was medicated with prednisolone, hydroxychloroquine, azathioprine, amlodipine and sildenafil. Extensive investigation suggested azathioprine-induced myelotoxicity. However, the patient was found to have a concomitant cytomegalovirus (CMV) infection, with oral lesions, positive CMV viral load as well as the previously described haematological findings. Pancytopenia is always a diagnostic challenge, with drug-induced myelotoxicity, especially secondary to azathioprine, being a rare aetiology. This report reiterates the importance of the differential diagnosis of pancytopenia, especially in immunosuppressed patients with increased risk for opportunistic infections.https://www.ejcrim.com/index.php/EJCRIM/article/view/1012Pancytopeniasystemic lupus erythematosusazathioprinecytomegalovirus |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Priscila Diaz Mariana Abreu Vieira António Carneiro Natália Fernandes |
spellingShingle |
Priscila Diaz Mariana Abreu Vieira António Carneiro Natália Fernandes A Case of Pancytopenia with Many Possible Causes: How Do You Tell Which is the Right One? European Journal of Case Reports in Internal Medicine Pancytopenia systemic lupus erythematosus azathioprine cytomegalovirus |
author_facet |
Priscila Diaz Mariana Abreu Vieira António Carneiro Natália Fernandes |
author_sort |
Priscila Diaz |
title |
A Case of Pancytopenia with Many Possible Causes: How Do You Tell Which is the Right One? |
title_short |
A Case of Pancytopenia with Many Possible Causes: How Do You Tell Which is the Right One? |
title_full |
A Case of Pancytopenia with Many Possible Causes: How Do You Tell Which is the Right One? |
title_fullStr |
A Case of Pancytopenia with Many Possible Causes: How Do You Tell Which is the Right One? |
title_full_unstemmed |
A Case of Pancytopenia with Many Possible Causes: How Do You Tell Which is the Right One? |
title_sort |
case of pancytopenia with many possible causes: how do you tell which is the right one? |
publisher |
SMC MEDIA SRL |
series |
European Journal of Case Reports in Internal Medicine |
issn |
2284-2594 |
publishDate |
2019-01-01 |
description |
Systemic lupus erythematosus (SLE) often presents with cytopenia(s); however, pancytopenia is found less commonly, requiring the consideration of possible aetiologies other than the primary disease. The authors describe the case of a female patient with a recent diagnosis of SLE admitted through the Emergency Department with fever of unknown origin and severe pancytopenia. She was medicated with prednisolone, hydroxychloroquine, azathioprine, amlodipine and sildenafil. Extensive investigation suggested azathioprine-induced myelotoxicity. However, the patient was found to have a concomitant cytomegalovirus (CMV) infection, with oral lesions, positive CMV viral load as well as the previously described haematological findings. Pancytopenia is always a diagnostic challenge, with drug-induced myelotoxicity, especially secondary to azathioprine, being a rare aetiology. This report reiterates the importance of the differential diagnosis of pancytopenia, especially in immunosuppressed patients with increased risk for opportunistic infections. |
topic |
Pancytopenia systemic lupus erythematosus azathioprine cytomegalovirus |
url |
https://www.ejcrim.com/index.php/EJCRIM/article/view/1012 |
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