Adverse Effects of Azathioprine in a Child and Her Mother with Eczema
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AbstractTo the Editor: Eczema is a common atopic condition [1, 2]. A few patients may suffer from recalcitrant disease that necessitates the usage of systemic immunomodulating medications such as azathioprine [3, 4]. Known side-effects include deranged liver function and neutropenia. Thiopurine S-methyl transferase (TPMT) activity and NUDT15 variants are known risk factors for thiopurine intolerance [3, 5, 6]. We report the adverse effects to azathioprine because of NUDT15 mutations of a girl and her mother treated with azathioprine for their eczema.

The patient had tried various forms of complementary and alternative medicine but avoided topical emollient and corticosteroid. Skin hydration was low, and quality of life was severely impaired. The mother requested systemic treatment. The patient, weighing 70 kg at age 17 y, was started on low dose azathioprine 50 mg per day. Liver function and complete blood count were normal prior to commencement of azathioprine. Anti-nuclear antibody (ANA) was positive at 1:420. When assessed at 4 wk of treatment, her eczema was much improved. Her liver function was normal but neutropenia was observed (white cell count dropped to 0.8 × 109/L, and neutrophil count 0.1 × 109/L). Azathioprine was discontinued. Neutrophil count returned to 1.8 × 109/L one week later. The girl remained well with no infection but went on to develop extensive alopecia within one week (Fig. 1). Pull test yielded 10–15 hairs with each pull. Eyebrow and eyelashes hair were spared. Within two weeks there was no further hair loss and new hair began to grow.
All Author(s) ListKam Lun HON, Mimi CHANG, Shuk Ching CHONG, Yuet Ping YUEN, Stephen Kwok Wing TSUI
Title of PublicationThe Indian Journal of Pediatrics
Volume Number85
Issue Number10
Pages918 - 919
LanguagesEnglish-United Kingdom

Last updated on 2020-24-10 at 03:47