Azathioprine-induced shock.

Azathioprine shock

“…The mechanism of the hypotension which may occur is uncertain; postulates include fluid loss from severe gastrointestinal upset or pancreatitis (Pozniak et al, 1981). Where pancreatitis has been reported hypotension has not been a feature and amylase levels are usually only two to three times the laboratory level of normal (Nogueira & Freedman, 1972;Sturdevant et al, 1979;Davis et al, 1980;Pozniak et al, 1981). Five reported cases with severe circulatory collapse have responded fairly quickly to treatment with fluid replacement.…”

Drug-Induced Acute Pancreatitis

“…(341,348) Azathioprine/6-mercaptopurine Numerous case-reports linking azathioprine, (25,29,52,(349)(350)(351)(352)(353)(354)(355)(356)(357)(358)(359)(360)(361)(362)(363)(364) and its metabolite 6-mercaptopurine (364)(365)(366)(367) to acute pancreatitis have been published, the majority with recurrence of pancreatitis after rechallenge. (25,(357)(358)(359)(360)(361)(362)(363)(364)(365) In addition, acute pancreatitis has been described in patients with systemic lupus erythematosus, (368,369) and in patients with renal transplants on immunosuppressive therapy that included azathioprine. (188,190,(370)(371)(372)(373) The occurrence of symptoms within weeks after starting azathioprine therapy, recurrence of symptoms within hours after rechallenge, and dose independency suggest an immune-mediated reaction.…”

Inhibitors of purine and pyrimidine synthesis: mycophenolate, azathioprine, and leflunomide

“…A recent pharmacoeconomic analysis based on a target case has suggested that pretreatment screening for TPMT mutations will reduce the risk of myelosuppression and may be cost beneficial (17). Other possible side effects of azathioprine are toxic hepatitis, pancreatitis, hypersensitivity syndrome (azathioprine‐induced shock), and drug fever (18–22). Many patients suffer from GI upset, but not enough to stop treatment.…”