title: Aplastic anemia secondary to azathioprine in systemic lupus erythematosus: report of a case with normal thiopurine S-methyltransferase enzyme activity and review of the literature.
abstract: Azathioprine-induced aplastic anemia and fatal myelosuppression is a rare occurrence in patients with systemic lupus erythematosus (SLE). We report a case of a 53-year-old female with a normal thiopurine S-methyltransferase (TPMT) level who developed aplastic anemia within 4 weeks of azathioprine initiation, resulting in death. Physicians should be vigilant in monitoring routine blood work when administering azathioprine, a relatively common drug, in patients with SLE.
authors.affiliation: 1Department of Rheumatology and Immunology, Los Angeles County-University of Southern California Medical Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Yeter
authors.forename: M
authors.initials: M
authors.lastname: Afkhami
authors.forename: R K
authors.initials: RK
authors.lastname: Brynes
authors.forename: F P
authors.initials: FP
authors.lastname: Quismorio
mesh_terms: D000741:Anemia, Aplastic / Q000139:chemically induced* / Q000503:physiopathology; D001379:Azathioprine / Q000009:adverse effects* / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008780:Methyltransferases / Q000378:metabolism; D008875:Middle Aged
chemical_list: D007166:Immunosuppressive Agents; D008780:Methyltransferases; C022745:thiopurine methyltransferase; D001379:Azathioprine
keywords: Systemic lupus erythematosus; azathioprine; hematologic changes; musculoskeletal