Severe pulmonary toxicity after azathioprine/6-mercaptopurine initiation for the treatment of inflammatory bowel disease.
Azathioprine and 6-mercaptopurine (6-MP) are effective in inflammatory bowel disease (IBD). However, between 10% and 29% of patients treated with these drugs are forced to stop therapy due to side effects. Pulmonary toxicity due to azathioprine/6-MP has been reported infrequently. We describe 3 patients who developed severe, noninfectious pulmonary toxicity within 1 month after the initiation of azathioprine or 6-MP for the treatment of IBD colitis (2 Crohn's disease and 1 ulcerative colitis). All patients presented with dyspnea, cough, and fever after initiation of azathioprine/6-MP. Evaluation for infectious etiologies, including bronchoscopy (3/3 patients) and open-lung biopsy (2/3 patients) was negative. Histopathologic examination of the lung biopsies revealed bronchiolitis obliterans organizing pneumonia in one, and usual interstitial pneumonitis in another patient. Cessation of purine analog therapy resulted in clinical improvement in all 3 cases. Azathioprine/6-MP-related pulmonary toxicity is a rare but serious side effect, and it is important for clinicians to have a high index of suspicion for this adverse reaction which occurs within 1 month after initiation of treatment for IBD.
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Ashwin N
AN
Ananthakrishnan
Tan
T
Attila
Mary F
MF
Otterson
Randolph J
RJ
Lipchik
Benson T
BT
Massey
Richard A
RA
Komorowski
David G
DG
Binion
D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000009:adverse effects*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008171:Lung Diseases / Q000139:chemically induced*; D008297:Male; D015122:Mercaptopurine / Q000009:adverse effects*; D012720:Severity of Illness Index
D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine