第三季新案例(2011年11月26日)

案例三: A 48 yo ethnic Chinese female living in the US has a long history of relatively stable chronic hepatitis B infection with normal liver function tests (LFT), normal alpha fetal protein (AFP) and normal liver ultrasound but a moderately high HBV titer of 256,000 IU/ml with negative surface antibody and e antigen.She was recently diagnosed with biopsy-confirmed Crohn’s colitis with marked segmental inflammation in the ascending colon and hepatic flexure associated with diarrhea and abdominal pain. She had a small bowel capsule endoscopy showing no involvement of the small bowel. Her symptoms did not respond completely to Lialda (slow release/long acting mesalamine) treatment and it was decided that Imuran (azathioprine) at a dose of 100 mg daily be added. Her diarrhea and abdominal pain symptoms responded very well to the treatment but she felt an extreme fatigue after starting Imuran. Her LFT showed a very mild elevation of total bilirubin to 2.2 mg/dL and direct bilirubin to 0.42 mg/dL with normal transaminases and alkaline phosphatase. Her blood WBC also decreased slightly to 3.6 from a baseline of 4.6. Her TPMT (thiopurine methyltransferase) level is normal at 15.9 U/ml. Her Imuran dose was decreased to 75 mg and then to 50 mg daily but her symptoms persisted and her blood test results did not change. However, her diarrhea began to increase and her abdominal pain also recurred. What would you do next?

 


回顾

第一期案例原文在:http://www.uschie.org/web/zh/current/96-gi-club/934--20110830

第一期案例原文与第二期案例在:http://www.uschie.org/web/en/current/96-gi-club/1032--giclub20111010

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