Azathioprine-Induced Rapid Hepatotoxicity

Area of Science:

• Hepatology
• Pharmacology
• Gastroenterology

Background:

• Azathioprine is an immunosuppressant commonly used for inflammatory conditions.
• Hepatotoxicity is a known adverse effect of azathioprine, though typically with later onset.
• Previous reports predominantly feature male patients with onset months after therapy initiation.

Purpose of the Study:

• To document a rare instance of rapid-onset azathioprine hepatotoxicity.
• To emphasize the potential for early adverse liver reactions to azathioprine.

Main Methods:

• A case study of a 62-year-old female with Crohn's disease is presented.
• The patient was initiated on azathioprine with a concurrent prednisone taper.
• Liver function tests were monitored closely following treatment initiation.

Main Results:

• Elevated liver enzymes were observed by the third day of azathioprine therapy.
• Peak enzyme levels were recorded on day 10, with significant elevations in AST, ALT, and ALP.
• Discontinuation of azathioprine led to normalization of liver enzymes within 3 weeks.

Conclusions:

• This case suggests azathioprine can cause rapid hepatotoxicity, even within days of starting therapy, particularly in female patients.
• Concurrent corticosteroid use may increase the risk of azathioprine-induced liver injury.
• Close monitoring of liver enzymes during the first week of azathioprine initiation is recommended, especially in patients on corticosteroids.