title: Azathioprine-induced pulmonary haemorrhage in a child after renal transplantation.
abstract: We report a case of azathioprine-induced haemorrhagic alveolitis, in a 14-year-old boy, after renal transplantation. On day 25 the patient developed haemoptysis, fever and hypoxaemia. Chest X-ray showed diffuse reticulo-nodular shadows in both lung fields. Bronchoalveolar lavage samples were haemorrhagic and demonstrated a relative neutrophilia and a mild lymphocytosis, with a normal CD4/CD8 ratio. Azathioprine was discontinued on day 26. The patient required mechanical ventilation for 4 days. A positive leucocyte migration inhibition test and the recurrence of the symptoms after a second short course of azathioprine therapy suggested a cell-mediated mechanism. This patient is, to our knowledge, the first child to suffer from azathioprine-induced pulmonary haemorrhage.
authors.affiliation: Service de Néphrologie, Hôpital d'Enfants Armand Trousseau, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Refabert
authors.forename: P
authors.initials: P
authors.lastname: Sinnassamy
authors.forename: B
authors.initials: B
authors.lastname: Leroy
authors.forename: B
authors.initials: B
authors.lastname: Fauroux
authors.forename: J
authors.initials: J
authors.lastname: de Blic
authors.forename: A
authors.initials: A
authors.lastname: Bensman
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001379:Azathioprine / Q000009:adverse effects*; D002634:Chemotaxis, Leukocyte / Q000502:physiology; D006470:Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation; D008171:Lung Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D011859:Radiography; D012129:Respiratory Function Tests
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine