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Azathioprine-induced severe cholestatic hepatitis in patient carrying TPMT*3C polymorphism
Chaker Ben Salem1, Lynda Ben Salah, Colandane Belajouza
1Department of Clinical Pharmacology, Faculty of Medicine of Sousse, Avenue Mohamed Karoui, 4002, Sousse, Tunisia. bensalem.c@gmail.com
Case Description:
A 40-year-old man with pemphigus foliaceus developed a jaundice and pruritus three weeks after starting azathioprine 100 mg daily. Laboratory investigations revealed a severe cholestatic hepatitis. Azathioprine-induced hepatitis was suspected. The dosage of thiopurine methyltransferase activity showed a low activity of the enzyme and the genotype of this enzyme found a TPMT*3C heterozygous mutant allele. Azathioprine was withdrawn. The icterus regressed progressively and the hepatic tests normalised slowly. The patient had no further episodes of hepatitis over a follow-up period of 6 months.
Conclusion:
Although, hematotoxicity seems to be associated with homozygous TPMT variants, a possible association between azathioprine hepatotoxicity and a TPMT*3C genotype should be investigated further.
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