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Laura Appel Møllehave1, Karl Emil Nelveg-Kristensen2

  • 1Endokrinologisk og Nefrologisk Afdeling, Københavns Universitetshospital - Nordsjællands Hospital.

Ugeskrift for Laeger
|November 25, 2022
PubMed
Summary

Azathioprine hypersensitivity syndrome (AHS) is a rare, severe reaction. Promptly stopping azathioprine (AZA) is crucial to prevent potentially fatal outcomes like renal failure.

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Area of Science:

  • Immunology
  • Dermatology
  • Nephrology

Background:

  • Azathioprine (AZA) is an immunosuppressive drug used in various conditions.
  • Hypersensitivity reactions to AZA can occur, though rare.

Observation:

  • A 57-year-old male developed circulatory collapse, systemic inflammation, and acute generalized exanthematous pustulosis after starting AZA.
  • Symptoms recurred rapidly upon AZA re-initiation, accompanied by anuric renal failure.

Findings:

  • The patient was diagnosed with azathioprine hypersensitivity syndrome (AHS), a type-IV hypersensitivity reaction.
  • Skin biopsy can aid in diagnosing AHS.
  • Discontinuation of AZA is essential upon suspected AHS.

Implications:

  • Early recognition and withdrawal of AZA are critical for managing AHS.
  • Avoiding re-exposure to AZA is vital to prevent severe adverse events.
  • This case highlights the importance of considering AHS in patients presenting with severe systemic reactions post-AZA initiation.

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