Azathioprine induced nodular regenerative hyperplasia in IBD patients.
Purine analogues are major drugs in the treatment of inflammatory bowel diseases (IBD). We present four cases of nodular regenerative hyperplasia of the liver (NRH) developed in patients with IBD treated with azathioprine. All patients had either abnormal liver tests and/or low platelet count. Although biochemical and hematological abnormalities regressed after azathioprine withdrawal, the long term evolution of the hepatic lesions (and the risk to develop further complications including portal hypertension) remains to be determined. Male gender seems to be a major risk factor by providing a predisposing pharmacogenetic profile of purine analogue metabolism. Clinicians should be aware of this serious complication which may occur with any of the purine analogues (azathioprine, 6-mercaptopurine, and 6-thioguanine).
Département d'Hépato-Gastroentérologie, Hôpital Européen Georges Pompidou, AP-HP, Paris.
Fady
F
Daniel
Jean-François
JF
Cadranel
Philippe
P
Seksik
Alain
A
Cazier
Jean-Paul
JP
Duong Van Huyen
Marianne
M
Ziol
Pierre
P
Coutarel
Patrick
P
Loison
Raymond
R
Jian
Philippe
P
Marteau
D000328:Adult; D001379:Azathioprine / Q000009:adverse effects* / Q000627:therapeutic use; D020518:Focal Nodular Hyperplasia / Q000139:chemically induced*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D007166:Immunosuppressive Agents; D001379:Azathioprine