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Acute Pancreatitis Induced by Azathioprine and 6-mercaptopurine Proven by Single and Low Dose Challenge Testing in a

Geum-Chae-Won Yi1, Ka-Hyun Yoon, Jin-Bok Hwang

  • 1Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea.

Pediatric Gastroenterology, Hepatology & Nutrition
|September 7, 2013
PubMed

Insights

This case study highlights drug-induced acute pancreatitis in a pediatric Crohn disease patient. Azathioprine and 6-mercaptopurine were identified as likely culprits using a single, low-dose challenge test.

Area of Science:

  • Gastroenterology and Hepatology
  • Clinical Pharmacology
  • Pediatric Medicine

Background:

  • Crohn disease management often involves immunomodulators and anti-inflammatory agents.
  • Acute pancreatitis is a rare but serious adverse drug reaction.
  • Identifying the causative agent in polypharmacy is clinically challenging.

Observation:

  • A 14-year-old boy with Crohn disease developed acute pancreatitis during treatment with mesalazine and azathioprine.
  • Symptoms included high fever and severe epigastric pain.
  • Laboratory tests and ultrasonography confirmed acute pancreatitis.

Findings:

  • Discontinuation of medications and supportive care led to symptom resolution.
  • A single, low-dose challenge test implicated azathioprine and 6-mercaptopurine (a metabolite of azathioprine) in inducing pancreatitis.
  • Mesalazine was ruled out as the causative agent.

Implications:

  • The single, low-dose challenge test is a valuable tool for diagnosing drug-induced pancreatitis.
  • Clinicians should consider azathioprine and 6-mercaptopurine as potential causes of pancreatitis in Crohn disease patients.
  • This case underscores the importance of careful medication review and diagnostic testing for adverse drug reactions.

Keywords:
6-mercaptopurineAcute pancreatitisAzathioprineChildCrohn diseaseInflammatory bowel diseasesMesalamine

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