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Probable azathioprine hepatotoxicity: a case report.

P Small¹, M Lichter

¹Division of Allergy and Clinical Immunology, SMBD-Jewish General Hospital, Montreal, Quebec, Canada.

Annals of Allergy

|June 1, 1989

Summary

Azathioprine can cause liver damage (hepatotoxicity) in polymyositis patients, even with prior corticosteroid treatment. This case highlights the importance of monitoring liver function during azathioprine therapy.

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Area of Science:

Immunology
Hepatology
Pharmacology

Background:

Polymyositis is an autoimmune disease causing muscle inflammation.
Corticosteroids are a common initial treatment for polymyositis.
Azathioprine is an immunosuppressant sometimes used as a steroid-sparing agent.

Observation:

A polymyositis patient on corticosteroids developed transient liver injury.
Azathioprine was added, leading to recurrent liver toxicity episodes.
Liver damage occurred approximately 3 weeks after initiating azathioprine.

Findings:

This is the first documented case of azathioprine-induced hepatotoxicity in polymyositis confirmed by liver biopsy.
Histopathology revealed characteristic signs of drug-induced liver injury.
A drug challenge with azathioprine reproduced the toxic liver injury.

Implications:

Clinicians should be vigilant for azathioprine hepatotoxicity in polymyositis patients.
Regular liver function monitoring is crucial during azathioprine treatment.
This case underscores the need for careful patient selection and monitoring when using azathioprine.

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