title: Multiple cutaneous neutropenic ulcers associated with azathioprine.
abstract: We report a case of neutropenic ulceration in a 42-year-old woman receiving azathioprine for pemphigus vulgaris. She developed multiple indolent ulcers involving the nose, neck, and back, after about 6-8 weeks following commencement of azathioprine 50 mg daily. The ulcers were large, disfiguring, dry, and with basal necrotic slough. They were painless and did not discharge pus. The absolute neutrophil count was severely depressed initially, but normalized following azathioprine withdrawal. Swab culture revealed colonization with Klebsiella pneumoniae and the ulcers healed with local debridement, treatment with imipenem, and topical application of mupirocin. However, nasal disfigurement persisted. Neutropenic ulceration is known to be associated with azathioprine therapy but we report this case because of the unusual presentation-indolent cutaneous ulcers. Early recognition of the problem and drug withdrawal can prevent complications like disfigurement.
authors.affiliation: Department of Anesthesiology and Critical Care, Command Hospital (Eastern Command), Alipore, India.
authors.forename: Baisakhi
authors.initials: B
authors.lastname: Laha
authors.forename: Rajib
authors.initials: R
authors.lastname: Guha
authors.forename: Avijit
authors.initials: A
authors.lastname: Hazra
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D009503:Neutropenia / Q000139:chemically induced* / Q000175:diagnosis*; D012883:Skin Ulcer / Q000139:chemically induced* / Q000175:diagnosis*
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine
keywords: Azathioprine; neutropenic ulcer; pemphigus vulgaris