title: Azathioprine hypersensitivity presenting as septic shock with encephalopathy.
abstract: We present a case of azathioprine hypersensitivity presenting as septic shock with associated encephalopathy. The patient was presented with rapid onset of fever, hypotension, confusion and a rapidly declining conscious level. He was admitted to the intensive care unit where he received numerous invasive investigations and treatments with broad-spectrum antibiotics, antivirals and antifungals. All microbial cultures were negative. The patient-consistent with azathioprine hypersensitivity-made a spontaneous recovery after 7 days. The case shows that a time line of drug initiation is a key part of the medical history and consideration of azathioprine hypersensitivity could avoid unnecessary interventions and excessive antimicrobial use.
authors.affiliation: Oxford University Hospitals Trust, Oxford, UK.
authors.forename: Antonia
authors.initials: A
authors.lastname: James
authors.forename: Jelena
authors.initials: J
authors.lastname: Blagojevic
authors.forename: Stuart W
authors.initials: SW
authors.lastname: Benham
authors.forename: Richard
authors.initials: R
authors.lastname: Cornall
authors.forename: John
authors.initials: J
authors.lastname: Frater
mesh_terms: D000368:Aged; D001379:Azathioprine / Q000009:adverse effects*; D001927:Brain Diseases / Q000139:chemically induced*; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D012772:Shock, Septic / Q000139:chemically induced*
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine