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Published on: February 3, 2012
Azathioprine-Induced Pancreatitis in a Patient With Autoimmune Hepatitis: A Case Report
Oikigbeme Oikeh1, Aparna Abhirami Rathnam1, Jazmin Mexia Cabrales1
1Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals / Elmhurst, Queens, USA.
Summary
Azathioprine (AZA) can cause acute pancreatitis (AIP) in autoimmune hepatitis (AIH) patients. Early recognition and switching to mycophenolate mofetil (MMF) ensures recovery and continued immunosuppression.
Area of Science:
- Gastroenterology
- Hepatology
- Clinical Pharmacology
Background:
- Autoimmune hepatitis (AIH) requires long-term immunosuppression.
- Azathioprine (AZA) is a common immunosuppressant, but carries risks.
- Drug-induced pancreatitis is a potential adverse effect of AZA therapy.
Purpose of the Study:
- To report a case of acute pancreatitis induced by azathioprine (AZA) in a patient with autoimmune hepatitis (AIH).
- To emphasize the importance of recognizing azathioprine-induced pancreatitis (AIP) early.
- To highlight mycophenolate mofetil (MMF) as an alternative immunosuppressant.
Main Methods:
- Case report of a 67-year-old woman with biopsy-proven AIH.
- Clinical presentation, laboratory findings, and imaging studies were analyzed.
- Medication history, specifically AZA initiation, was reviewed.
- Exclusion of common pancreatitis etiologies.
Main Results:
- The patient developed acute pancreatitis within weeks of starting AZA and budesonide.
- Common causes of pancreatitis were excluded.
- Discontinuation of AZA led to complete clinical recovery.
- Transition to MMF for immunosuppression was successful.
Conclusions:
- Azathioprine-induced pancreatitis (AIP) is a critical diagnosis to consider in AIH patients starting AZA.
- Prompt recognition and drug withdrawal are key to patient recovery.
- Mycophenolate mofetil (MMF) is a safe and effective alternative for immunosuppression in patients intolerant to AZA.
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