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1例66a类风湿关节炎女性患者在使用来氟米特(20 mg,qd,po)联合甲氨蝶呤(7.5 mg,qw,po)治疗1个月后出现口唇溃疡,血常规示三系明显降低。立即住院治疗。住院期间血象继续降低,达粒细胞缺乏症、严重血小板减少症及重度贫血水平;并出现腹痛,莫非氏征阳性。患者加用来氟米特与甲氨蝶呤治疗前血常规基本正常,但有慢性胆囊炎病史,因此考虑来氟米特与甲氨蝶呤合用致严重骨髓抑制伴机会性感染即慢性胆囊炎急性发作。予停用来氟米特与甲氨蝶呤。同时输注浓缩红细胞、机采血小板、使用重组人粒细胞集落刺激因子升白、抗感染等对症治疗。患者血细胞逐渐回升、胆囊炎得到控制,病情趋于稳定。
One patient with rheumatoid arthritis of type 66a developed lip ulcers 1 month after treatment with leflunomide (20 mg, qd, po) plus methotrexate (7.5 mg, qw, po) Obvious reduction. Immediate hospitalization. Blood continued to decrease during hospitalization, the agranulocytosis, severe thrombocytopenia and severe anemia; and abdominal pain, Moxi sign positive. Patients with leflunomide and methotrexate before treatment of blood normal basically, but the history of chronic cholecystitis, consider leflunomide and methotrexate combined with severe myelosuppression with opportunistic infection that chronic cholecystitis Acute attack. To stop taking leflunomide and methotrexate. Concomitant infusion of concentrated red blood cells, machine-picked platelets, the use of recombinant human granulocyte colony stimulating factor lightening, anti-infection symptomatic treatment. Patient blood cells gradually picked up, cholecystitis was controlled, the condition stabilized.