Mercaptopurine
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Mercaptopurine Erythrodysaesthesia in a child: case report A 4-year-old boy developed erythrodysaesthesia [hand-foot syndrome] whilst receiving mercaptopurine for acute lymphoblastic leukaemia. The boy had been undergoing treatment for his leukaemia for 15 months based on the EORTC protocol 58951. Following complete remission with induction therapy, he began maintenance with mercaptopurine 50 mg/m2/day, methotrexate and cotrimoxazole [sulfamethoxazole/ trimethoprim]. Due to insufficient response, the dose of mercaptopurine was increased to 70 mg/m2/day, 106 mg/m2/day, then 180 mg/m2/day at the end of 6 months’ treatment. Three weeks after the last dose increase, he developed a red dry erythema on his hands and feet, which was painful and had fissures [duration of therapy to reaction onset not clearly stated]. He had applied betamethasone dipropionate cream for one week without improvement. On examination, the erythema was clearly defined with desquamative margins, and there were signs of erosive digital pulpitis. Mercaptopurine toxicity was suspected and the drug was switched to tioguanine; methotrexate was continued. Within 14 days the eruption had resolved, and the boy had no relapse during 6-months’ follow-up. Author comment: The association between the adverse reaction and mercaptopurine was considered probable, based on the symptoms and temporal relationship. . . The case presented here confirms involvement of a dose-dependent mechanism. . . The possibility of an interaction with methotrexate, particularly with the increase in bioavailability of mercaptopurine, cannot be excluded. Giacchero D, et al. 6-Mercaptopurine-related hand-foot syndrome in a four-yearold child. Annales de Dermatologie et de Venereologie 135: 580-583, No. 8-9, 801124701 Aug-Sep 2008 [French; summarised from a translation] - France
0114-9954/10/1231-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 6 Dec 2008 No. 1231
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