Porto-Sinusoidal Vascular Disease with Obliterative Portal Venopathy Associated with Long-Term Azathioprine for Crohn’s Disease

Abstract

Patients receiving immunosuppressive therapy for inflammatory bowel disease may be susceptible to non-cirrhotic portal hypertension, now referred to as porto-sinusoidal vascular disease. Here we describe a patient treated with long-term azathioprine for Crohn's disease who developed porto-sinusoidal vascular disease with obliterative portal venopathy without nodular regenerative hyperplasia on histology. Specific signs of portal hypertension were present, including porto-systemic collaterals on imaging. Histopathologic findings of porto-sinusoidal vascular disease support the hypothesis of endothelial cell injury induced by 6-thioguanine secondary to azathioprine use.