title: [Nodular regenerative hyperplasia as a side effect of azathioprine in a patient with Crohn's disease].
abstract: METHODS
  A 48-year-old patient with Crohn's disease was admitted to our hospital with fatigue, icterus, hepatosplenomegaly and ascites. INVESTIGARTIOS: The whole blood count revealed a pancytopenia, hyperbilirubinemia and slightly elevated transaminases. Examination of the liver histology showed areas of enlarged hyperplastic hepatocytes adjacent to areas of atrophic hepatocytes and dilated sinusoids.
  
  
  METHODS
  Pancytopenia was most likely azathioprine-related. Analysis of the liver histology was highly suggestive of an azathioprine-related, nodular regenerative hyperplasia (NRH). After discontinuation of azathioprine the patient's condition improved substantially.
  
  
  CONCLUSIONS
  NRH is a rare but potentially serious complication of azathioprine therapy. Other causes include various rheumatological, vascular and myeloproliferative diseases. When azathioprine is prescribed it must be borne in mind that it can cause NRH as a potential adverse effect, and liver enzymes should be measured at regular follow-up examinations.
authors.affiliation: Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité Universitätsmedizin Berlin. michael.schumann@charite.de
authors.forename: M
authors.initials: M
authors.lastname: Schumann
authors.forename: J C
authors.initials: JC
authors.lastname: Preiss
authors.forename: C
authors.initials: C
authors.lastname: Loddenkemper
authors.forename: U
authors.initials: U
authors.lastname: Günther
authors.forename: R
authors.initials: R
authors.lastname: Somasundaram
authors.forename: B
authors.initials: B
authors.lastname: Siegmund
authors.forename: M
authors.initials: M
authors.lastname: Zeitz
mesh_terms: D001201:Ascites / Q000209:etiology; D001379:Azathioprine / Q000009:adverse effects* / Q000627:therapeutic use; D001772:Blood Cell Count; D003424:Crohn Disease / Q000188:drug therapy*; D003937:Diagnosis, Differential; D005221:Fatigue / Q000209:etiology; D020518:Focal Nodular Hyperplasia / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007565:Jaundice / Q000209:etiology; D008099:Liver / Q000201:enzymology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010198:Pancytopenia / Q000139:chemically induced
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine