title: [Thiopurine-induced hyperammonaemic encephalopathy in a patient with Crohn's disease].
abstract: Thiopurine drugs, azathioprine (Imuran) and 6-mercaptopurine (6-MP), are immunomodulators that have been shown to be effective at inducing and maintaining remission in inflammatory bowel disease. Although usually well-tolerated, the occurrence of side effects, typically myelotoxicity and hepatotoxicity, is a major drawback. The side effects can be classified as dose-dependent and independent. Both cholestatic hepatitis and endothelial injury, leading to vascular congestion and nodular regenerative hyperplasia, have been described during therapy with thiopurines, which can end up with portal hypertension. These injuries are potentially mediated by different metabolites. In this article we present a case of hyperammonaemic encephalopathy during therapy with 6-MP, possibly the first recorded in the literature, which probably resulted from the combination of thiopurine-induced liver injury with portal hypertension and the presence of spontaneous portosystemic venous shunts.
authors: Gastroenterology and Hepatology Institute, Meir Medical Center.
authors: Ido
authors: I
authors: Laish
authors: Itamar
authors: I
authors: Pomeranz
authors: Yona
authors: Y
authors: Kitay-Cohen
authors: Fred
authors: F
authors: Konikof
mesh_terms: D000368:Aged; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000503:physiopathology; D003424:Crohn Disease / Q000188:drug therapy; D006501:Hepatic Encephalopathy / Q000139:chemically induced*; D006801:Humans; D022124:Hyperammonemia / Q000139:chemically induced*; D006975:Hypertension, Portal / Q000139:chemically induced; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011169:Portal Vein / Q000002:abnormalities
chemical_list: D007166:Immunosuppressive Agents; D015122:Mercaptopurine