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Case Reports
. 2023 Apr 14;10(4):e00990.
doi: 10.14309/crj.0000000000000990. eCollection 2023 Apr.

Azathioprine-Induced Hypersensitivity Vasculitis

Michael Sangiorgio  1 , Anil Bhagwat  1 , Christopher Middleton  1 , Alex Davies  1
Affiliations
Case Reports

Azathioprine-Induced Hypersensitivity Vasculitis

Michael Sangiorgio et al. ACG Case Rep J. .

Abstract

Vasculitic skin rash is a rare but known manifestation of azathioprine hypersensitivity reactions, with several published case reports. In this report, we describe the case of a 63-year-old man on azathioprine for autoimmune hepatitis, who developed a delayed systemic hypersensitivity reaction with biopsy-proven vasculitis, approximately 10 months into his treatment. This resolved after azathioprine discontinuation and has not recurred to date after subsequent administration of 6-mercaptopurine. This case highlights the need for continued monitoring for delayed hypersensitivity reactions to azathioprine after initiation of therapy.

Keywords: autoimmune hepatitis; azathioprine; hypersensitivity; vasculitis.

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Figures

Figure 1.
Figure 1.
Cutaneous manifestation of hypersensitivity reaction, with pustular target shaped lesions on lower limb.
Figure 2.
Figure 2.
Histology of skin biopsy, showing fibrinoid change within small vessels (red arrow) associated with perivascular inflammatory debris (blue arrow), consistent with a hypersensitivity vasculitis.
See this image and copyright information in PMC

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