Answer BOF 40

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BOF: 40

A 46-year-old male, who has long-standing Crohn’s disease and is on azathioprine to maintain remission, is admitted with pneumonia.

He has also been started on treatment for gout by his GP

Investigations are as follows:

Hb 14.3 g/dl

WBC 0.8 x 10⁹/L

Platelets 85 x 10⁹/L

Chest X-ray shows a right basal consolidation

In this patient which of the following drugs is the GP likely to have prescribed for his gout?

a)      Colchicine

b)      Allopurinol

c)      Diclofenac

d)      Aspirin

e)      Ibuprofen

Answer: b)

The patient has evidence of bone marrow toxicity due to azathioprine. Allopurinol is a xanthine oxidase inhibitor. Xanthine oxidase is an enzyme involved in the metabolism of azathioprine and concurrent use of allopurinol will increase azathioprine levels and cause bone marrow toxicity.

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