Abstract
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 Azathioprine was withdrawn.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.
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Ben Salem, C., Ben Salah, L., Belajouza, C. et al. Azathioprine-induced severe cholestatic hepatitis in patient carrying TPMT*3C polymorphism. Pharm World Sci 32, 701–703 (2010). https://doi.org/10.1007/s11096-010-9443-4
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DOI: https://doi.org/10.1007/s11096-010-9443-4