Azathioprine Hypersensitivity Syndrome: Two Cases of Febrile Neutrophilic Dermatosis Induced by Azathioprine
Background: Azathioprine is an immunosuppressive agent used in the treatment of immune-mediated diseases. Azathioprine hypersensitivity syndrome is a rare adverse reaction occurring a few days to weeks after the administration of azathioprine. Case 1: A 36-year-old male with ulcerative colitis prese...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2017-01-01
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| Series: | Case Reports in Dermatology |
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| Online Access: | http://www.karger.com/Article/FullText/454876 |
| _version_ | 1819101310002135040 |
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| author | Majed Aleissa Perrine Nicol Marion Godeau Emilie Tournier Frederic de Bellissen Marie-Angèle Robic Cristina Bulai Livideanu Juliette Mazereeuw-Hautier Carle Paul |
| author_facet | Majed Aleissa Perrine Nicol Marion Godeau Emilie Tournier Frederic de Bellissen Marie-Angèle Robic Cristina Bulai Livideanu Juliette Mazereeuw-Hautier Carle Paul |
| author_sort | Majed Aleissa |
| collection | DOAJ |
| description | Background: Azathioprine is an immunosuppressive agent used in the treatment of immune-mediated diseases. Azathioprine hypersensitivity syndrome is a rare adverse reaction occurring a few days to weeks after the administration of azathioprine. Case 1: A 36-year-old male with ulcerative colitis presented with erythematous plaques, pustules and erosions on the lower back, buttocks and thighs associated with high fever (39°C) 2 weeks after the initiation of azathioprine 100 mg/day. Additional findings included leukocytosis (18.6 g/L) with neutrophilia (11.1 g/L) and elevated C-reactive protein (128 mg/L). Histopathology showed a dense infiltrate of neutrophils in the hair follicles. We increased the dose of prednisone to 1 mg/kg/day (60 mg/day) and azathioprine was discontinued. He had marked improvement within 3 weeks and did not have any relapse with a 1-year follow-up. Case 2: A 57-year-old male with ulcerative colitis presented with erythematous plaques and pustules on the lower limbs associated with high fever (40°C) 1 week after the initiation of azathioprine 75 mg/day. Leukocytosis with neutrophilia (13.6 g/L) and elevated C-reactive protein (344 mg/L) were among the laboratory findings. Histopathology showed a dense infiltrate of neutrophils in the hair follicles. The dose of prednisone was increased to 20 mg/day and azathioprine was discontinued, which led to complete remission within 7 days. He did not have any relapse with a 6-month follow-up. Conclusion: The development of acute neutrophilic dermatitis 2 weeks after the initiation of azathioprine and the complete resolution after its withdrawal were in favor of azathioprine hypersensitivity syndrome. It should not be confused with Sweet syndrome associated with inflammatory bowel disease, as maintenance of azathioprine treatment may lead to life-threatening reactions. |
| first_indexed | 2024-12-22T01:16:38Z |
| format | Article |
| id | doaj.art-2cd9cbe53aaf487886b5b50f05f6a717 |
| institution | Directory Open Access Journal |
| issn | 1662-6567 |
| language | English |
| last_indexed | 2024-12-22T01:16:38Z |
| publishDate | 2017-01-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Dermatology |
| spelling | doaj.art-2cd9cbe53aaf487886b5b50f05f6a7172022-12-21T18:43:50ZengKarger PublishersCase Reports in Dermatology1662-65672017-01-019161110.1159/000454876454876Azathioprine Hypersensitivity Syndrome: Two Cases of Febrile Neutrophilic Dermatosis Induced by AzathioprineMajed AleissaPerrine NicolMarion GodeauEmilie TournierFrederic de BellissenMarie-Angèle RobicCristina Bulai LivideanuJuliette Mazereeuw-HautierCarle PaulBackground: Azathioprine is an immunosuppressive agent used in the treatment of immune-mediated diseases. Azathioprine hypersensitivity syndrome is a rare adverse reaction occurring a few days to weeks after the administration of azathioprine. Case 1: A 36-year-old male with ulcerative colitis presented with erythematous plaques, pustules and erosions on the lower back, buttocks and thighs associated with high fever (39°C) 2 weeks after the initiation of azathioprine 100 mg/day. Additional findings included leukocytosis (18.6 g/L) with neutrophilia (11.1 g/L) and elevated C-reactive protein (128 mg/L). Histopathology showed a dense infiltrate of neutrophils in the hair follicles. We increased the dose of prednisone to 1 mg/kg/day (60 mg/day) and azathioprine was discontinued. He had marked improvement within 3 weeks and did not have any relapse with a 1-year follow-up. Case 2: A 57-year-old male with ulcerative colitis presented with erythematous plaques and pustules on the lower limbs associated with high fever (40°C) 1 week after the initiation of azathioprine 75 mg/day. Leukocytosis with neutrophilia (13.6 g/L) and elevated C-reactive protein (344 mg/L) were among the laboratory findings. Histopathology showed a dense infiltrate of neutrophils in the hair follicles. The dose of prednisone was increased to 20 mg/day and azathioprine was discontinued, which led to complete remission within 7 days. He did not have any relapse with a 6-month follow-up. Conclusion: The development of acute neutrophilic dermatitis 2 weeks after the initiation of azathioprine and the complete resolution after its withdrawal were in favor of azathioprine hypersensitivity syndrome. It should not be confused with Sweet syndrome associated with inflammatory bowel disease, as maintenance of azathioprine treatment may lead to life-threatening reactions.http://www.karger.com/Article/FullText/454876AzathioprineAzathioprine hypersensitivity syndromeDrug reactionNeutrophilic dermatosisSweet syndromeInflammatory bowel disease |
| spellingShingle | Majed Aleissa Perrine Nicol Marion Godeau Emilie Tournier Frederic de Bellissen Marie-Angèle Robic Cristina Bulai Livideanu Juliette Mazereeuw-Hautier Carle Paul Azathioprine Hypersensitivity Syndrome: Two Cases of Febrile Neutrophilic Dermatosis Induced by Azathioprine Case Reports in Dermatology Azathioprine Azathioprine hypersensitivity syndrome Drug reaction Neutrophilic dermatosis Sweet syndrome Inflammatory bowel disease |
| title | Azathioprine Hypersensitivity Syndrome: Two Cases of Febrile Neutrophilic Dermatosis Induced by Azathioprine |
| title_full | Azathioprine Hypersensitivity Syndrome: Two Cases of Febrile Neutrophilic Dermatosis Induced by Azathioprine |
| title_fullStr | Azathioprine Hypersensitivity Syndrome: Two Cases of Febrile Neutrophilic Dermatosis Induced by Azathioprine |
| title_full_unstemmed | Azathioprine Hypersensitivity Syndrome: Two Cases of Febrile Neutrophilic Dermatosis Induced by Azathioprine |
| title_short | Azathioprine Hypersensitivity Syndrome: Two Cases of Febrile Neutrophilic Dermatosis Induced by Azathioprine |
| title_sort | azathioprine hypersensitivity syndrome two cases of febrile neutrophilic dermatosis induced by azathioprine |
| topic | Azathioprine Azathioprine hypersensitivity syndrome Drug reaction Neutrophilic dermatosis Sweet syndrome Inflammatory bowel disease |
| url | http://www.karger.com/Article/FullText/454876 |
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