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1例29岁男性患者因克罗恩病给予英夫利西单抗300 mg静脉滴注,首次给药后第4天血常规检查:白细胞计数4.63×109/L,中性粒细胞计数2.39×109/L,血红蛋白144 g/L,血小板计数138×109/L。第2次给药后25 d患者肢体皮肤出现针尖大小紫色瘀点,实验室检查:白细胞计数2.07×109/L,血红蛋白109 g/L,血小板计数10×109/L。给予重组人粒细胞集落刺激因子和重组人血小板生成素,并间断输血,但外周血细胞计数进行性下降。结合骨髓涂片检查和骨髓活检结果,诊断为再生障碍性贫血。给予美罗培南、氢化可的松、促红细胞生成素、环孢素、司坦唑醇、兔抗人胸腺细胞免疫球蛋白、更昔洛韦等治疗。约2个月后复查:白细胞计数2.06×109/L,中性粒细胞计数1.62×109/L,红细胞计数2.51×1012/L,血红蛋白73 g/L,血小板计数24×109/L。患者出院,继续环孢素治疗。次日患者出现发热,7 d后双上肢、背部散在出现紫红色瘀点。患者再次入院,血常规检查:白细胞计数4.59×109/L,中性粒细胞计数3.80×109/L,红细胞计数2.45×1012/L,血红蛋白74 g/L,血小板计数56×109/L。诊断为重型再生障碍性贫血。尽管全力救治,但患者终因重度贫血(血红蛋白降至38 g/L)、重症感染、出血而死亡。
A 29-year-old man with a Crohn’s disease was given 300 mg of infliximab for intravenous drip. On the fourth day after the first administration, blood tests were performed: white blood cell count 4.63 × 109 / L, neutrophil count 2.39 × 109 / L, hemoglobin 144 g / L, platelet count 138 × 109 / L. On the 25th day after the second administration, the needle-like purple petechiae appeared in the skin of the patients. The laboratory tests showed that the white blood cell count was 2.07 × 109 / L, the hemoglobin was 109 g / L and the platelet count was 10 × 109 / L. Recombinant human granulocyte-colony stimulating factor and recombinant human thrombopoietin were given and blood transfusion was interrupted, but peripheral blood cell counts decreased progressively. Combined with bone marrow smear and bone marrow biopsy results, diagnosis of aplastic anemia. Given meropenem, hydrocortisone, erythropoietin, cyclosporine, stanozolol, rabbit anti-human thymocyte immunoglobulin, ganciclovir and other treatment. About 2 months after the review: white blood cell count 2.06 × 109 / L, neutrophil count 1.62 × 109 / L, erythrocyte count 2.51 × 1012 / L, hemoglobin 73 g / L, platelet count 24 × 109 / L. Patients were discharged and ciclosporin treatment continued. The next day the patient developed fever, double upper extremities after 7 days, and purple red petechia scattered on his back. Patients were re-admitted to hospital for examination of blood samples. The white blood cell count was 4.59 × 109 / L, the neutrophil count was 3.80 × 109 / L, the erythrocyte count was 2.45 × 1012 / L, the hemoglobin was 74 g / L, and the platelet count was 56 × 109 / L. Diagnosis of severe aplastic anemia. Despite intensive care, patients eventually die of severe anemia (hemoglobin down to 38 g / L), severe infection, and bleeding.