Azathioprine-associated interstitial pneumonitis

F. Nagy; T. Molnár; É Makula; L. Tiszlavitz; I. Kiss; P. Milassin; É Zöllei; J. Lonovics

doi:10.1055/s-2005-869734

Zeitschrift für Gastroenterologie, Table of Contents

Azathioprine-associated interstitial pneumonitis

F Nagy ¹, T Molnár ¹, É Makula ², L Tiszlavitz ³, I Kiss ², P Milassin ², É Zöllei ⁴, J Lonovics ¹

¹First Department of Medicine, University of Szeged, Hungary
²Department of Radiology, University of Szeged
³Department of Pathology, University of Szeged
⁴Intensive Care Unit, University of Szeged

Abstract

Background: An early hypersensitivity reaction and late bone marrow depression are well known side-effects of azathioprine; interstitial pneumonia is a rare complication.

Case report: A 40-year-old male patient was treated with azathioprine due to extensive ulcerative colitis for 10 years. He complained of 7 days of fever, cough and catarrhal signs, without symptoms of active colitis. Opportunistic infections were ruled out. The chest X-ray, CT and lung biopsy demonstrated the presence of interstitial inflammation. The azathioprine therapy was discontinued as the potential source of the pulmonary infiltrate. As a result of steroid therapy, together with emergency unit care, the pulmonary infiltrate gradually decreased. Three months later his ulcerative colitis relapsed, and ileo-anal pouch surgery was performed.

Conclusion: In atypical pneumonia without the proven presence of an opportunistic infection, azathioprine-associated interstitial pneumonitis may be involved, which heals after the cessation of the drug administration.