Title:Azathioprine-induced Veno-occlusive Hepatotoxicity in a Patient with Myasthenia
Gravis
Volume: 19
Author(s): Nikhil Dongre, Jayantee Kalita*Usha K Misra
Affiliation:
- Department of neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar
Pradesh, India-226104
Keywords:
Azathioprine, myasthenia gravis, vena-occlusive, Hepatotoxicity, toxicity, acetylcholine receptor
Abstract: Introduction: Myasthenia gravis (MG) is an autoimmune disorder of post-synaptic
neuromuscular junction characterised by fatigable muscle weakness and is treated with prednisolone
with or without other immunosuppressants, including azathioprine (AZA). Veno-occlusive
hepatotoxicity of AZA is a rare complication in MG.
Case report: We report a 35-year-old man with MG who was treated with pyridostigmine, prednisolone,
and AZA for 5 years. He presented with abdominal pain and increased fatiguability for
7 days. His serum bilirubin and liver enzymes were elevated, and ultrasound revealed a dilated
hepatic vein and portal vein suggestive of veno-occlusive liver disease. The clinical symptoms,
liver functions, and ultrasound of the hepatobiliary system normalized after withdrawal of AZA.
Conclusion: A possibility of AZA veno-occlusive hepatoxicity should be considered in an MG
patient if presented with abdominal pain, elevated bilirubin and transaminases and ultrasound
showing dilatation of hepatic veins. Physicians should be aware of this complication because this
toxicity is reversible following dose reduction or withdrawal of AZA.
