New onset of atrial fibrillation after introduction of azathioprine in ulcerative colitis: case report and review of the literature.
METHODS
We present the case of a 52-year-old man with steroid-dependent ulcerative colitis, needing immunosuppressive therapy with azathioprine. The drug had been started 3 years earlier, but stopped after a few months because the patient reported palpitations, lipothymia, nausea and vomiting. Given the continued steroid-dependent ulcerative colitis and the lack of clinical documentation about a reaction with a dubious relationship to azathioprine, we decided to rechallenge the patient with the drug under clinical monitoring and after informed consent. After starting 50 mg of azathioprine, the patient showed general malaise, nausea and vomiting. An ECG showed atrial fibrillation, and the patient reported that the symptoms were similar to those previously experienced.


CONCLUSIONS
We have found two other cases of similar onset of atrial fibrillation after azathioprine use, although some confounding elements in these episodes make the possible causal relationship between the drug and this adverse event uncertain.
Cassinotti
Andrea
A
Department of Clinical Science, Gastroenterology Unit, L. Sacco University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy. andreacassinotti@libero.it
Massari
Alessandro
A
Ferrara
Elisa
E
Greco
Salvatore
S
Bosani
Matteo
M
Ardizzone
Sandro
S
Bianchi Porro
Gabriele
G
D001281:Atrial Fibrillation / Q000139:chemically induced* / Q000150:complications; D001379:Azathioprine / Q000009:adverse effects* / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged
D007166:Immunosuppressive Agents; D001379:Azathioprine