Pharmacy World & Science

, Volume 32, Issue 6, pp 701–703 | Cite as

Azathioprine-induced severe cholestatic hepatitis in patient carrying TPMT*3C polymorphism

  • Chaker Ben SalemEmail author
  • Lynda Ben Salah
  • Colandane Belajouza
  • Kamel Bouraoui
Case Report


Case description A 40-year-old man with pemphigus foliaceus developed a jaundice and pruritis three weeks after starting azathioprine 100 mg daily. Laboratory investigations revealed a severe cholestatic hepatitis. Azathioprine-induced hepatitis was suspected. The dosage of thiopurine methyltransferase activity showed a low activity of the enzyme and the genotype of this enzyme found a TPMT*3C heterozygous mutant allele. Azathioprine was withdrawn. The icterus regressed progressively and the hepatic tests normalised slowly. The patient had no further episodes of hepatitis over a follow-up period of 6 months. Conclusion Although, hematotoxicity seems to be associated with homozygous TPMT variants, a possible association between azathioprine hepatotoxicity and a TPMT*3C genotype should be investigated further.


Adverse drug reaction Azathioprine AZT Cholestatic hepatitis Pharmacogenetics  TPMT variants 


Conflicts of interest

There are no conflicts of interest.


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Chaker Ben Salem
    • 1
    Email author
  • Lynda Ben Salah
    • 2
  • Colandane Belajouza
    • 3
  • Kamel Bouraoui
    • 1
  1. 1.Department of Clinical PharmacologyFaculty of Medicine of SousseSousseTunisia
  2. 2.Department of BiophysicsFaculty of Medicine of SousseSousseTunisia
  3. 3.Department of DermatologyFarhat Hached HospitalSousseTunisia

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