title: Nodular regenerative hyperplasia: a reversible entity associated with azathioprine therapy.
abstract: Azathioprine represents an effective and widely used immunosuppressant; however, there are increasing concerns about the hepatotoxicity of thiopurines because of an entity called "nodular regenerative hyperplasia" (NRH) observed in patients treated with 6-thioguanine. In line with this hypothesis, we report and comment on a patient with inflammatory bowel disease (IBD) diagnosed with NRH as a reversible but potentially serious hepatotoxic side-effect of azathioprine. Our report strengthens the importance of further safety studies to evaluate the aetiology and prevalence of NRH in IBD patients before general conclusions on the use of thiopurines can be drawn. Physicians caring for IBD patients need to be alert to this rare but serious complication.
authors.affiliation: Department of Internal Medicine II, University of Munich, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany. julia.seiderer@med.uni-muenchen.de
authors.forename: Julia
authors.initials: J
authors.lastname: Seiderer
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Zech
authors.forename: Joachim
authors.initials: J
authors.lastname: Diebold
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: Stephan
authors.initials: S
authors.lastname: Brand
authors.forename: Cornelia
authors.initials: C
authors.lastname: Tillack
authors.forename: Burkhard
authors.initials: B
authors.lastname: Göke
authors.forename: Thomas
authors.initials: T
authors.lastname: Ochsenkühn
mesh_terms: D001379:Azathioprine / Q000009:adverse effects*; D003424:Crohn Disease / Q000188:drug therapy*; D020518:Focal Nodular Hyperplasia / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine