title: Mercaptopurine-induced hepatoportal sclerosis in a patient with Crohn's disease.
abstract: Thiopurines play a pivotal role in the management of inflammatory bowel disease. Azathioprine and mercaptopurine have been associated with a number of liver abnormalities, including hepatitis, veno-occlusive disease, nodular regenerative hyperplasia, and peliosis hepatitis. Patients treated with azathioprine and mercaptopurine have their liver chemistry tests routinely checked due to this potential for hepatotoxicity. Hepatoportal sclerosis is a cause of non-cirrhotic portal hypertension that is increasingly being recognized; its etiopathogenesis is not well defined. We present the first case report of mercaptopurine-induced hepatoportal sclerosis leading to non-cirrhotic portal hypertension in a patient with Crohn's disease. He had been treated with mercaptopurine for five years, and his liver chemistry tests were always within normal limits. This case underscores the potential serious liver adverse events that may arise silently and go undetected during treatment with mercaptopurine, and should alert clinicians as to the potential need to discontinue mercaptopurine in this setting.
authors: Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, United States.
authors: Ana C
authors: AC
authors: Tuyama
authors: Mark
authors: M
authors: Krakauer
authors: Mohamed
authors: M
authors: Alzaabi
authors: Maria Isabel
authors: MI
authors: Fiel
authors: Peter
authors: P
authors: Legnani
authors: Thomas D
authors: TD
authors: Schiano
mesh_terms: D001201:Ascites / Q000628:therapy; D003424:Crohn Disease / Q000188:drug therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000139:chemically induced* / Q000473:pathology; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007415:Intestinal Obstruction / Q000628:therapy; D008111:Liver Function Tests; D008297:Male; D015122:Mercaptopurine / Q000009:adverse effects*; D011168:Portal System / Q000473:pathology*; D012598:Sclerosis / Q000139:chemically induced / Q000473:pathology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D015122:Mercaptopurine