Principles of Systemic Therapy

Tidman, Michael J.; Smith, Kay Hogan

doi:10.1002/9781118441213.rtd0019

Cited by 1 publication

(2 citation statements)

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“…7 Genetic polymorphisms in the inositol triphosphate pyrophosphatase gene may also be associated with azathioprine hypersensitivity. 8 Photosensitivity with azathioprine has also been studied previously.…”

Section: Discussionmentioning

confidence: 99%

“…The imidazole (methyl nitroimidazole moiety) component in azathioprine was thought to associate with specific proteins generating haptens and causing type 3 hypersensitivity reactions after immune complex deposition over the vessel walls 7 . Genetic polymorphisms in the inositol triphosphate pyrophosphatase gene may also be associated with azathioprine hypersensitivity 8 . Photosensitivity with azathioprine has also been studied previously.…”

Section: Discussionmentioning

confidence: 99%

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Azathioprine hypersensitivity: A Sweet‐like syndrome

Sivanandam,

Begum,

Martinez

et al. 2023

Int J of Rheum Dis

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IntroductionAzathioprine hypersensitivity can occasionally present as Sweet‐like syndrome, a dose‐independent side effect characterized by the unanticipated onset of macules, papules, and pustules.Case presentationA 35‐year‐old woman with systemic lupus erythematosus presented with complaints of generalized maculopapular rash, facial swelling, and bilateral lower extremity edema with a duration of 4 days and a 2‐day history of constitutional symptoms within 2 weeks of the beginning of azathioprine therapy to treat existing lupus nephritis (class 2/3).DiscussionPatients who experience azathioprine hypersensitivity syndrome can present with erythema nodosum, small‐vessel vasculitis, acute generalized exanthematous pustulosis, Sweet syndrome, and nonspecific dermatosis. The following signs and symptoms are used as criteria to diagnose drug‐induced Sweet syndrome: (a) abrupt onset of painful erythematous plaques, (b) histopathological evidence of dense neutrophilic infiltrate without evidence of leukocytoclastic vasculitis, (c) temperature higher than 39.7°C, (d) temporal relationship between drug ingestion and clinical presentation, and (e) temporal resolution of lesions after drug withdrawal. Our patient met three out of five criteria and was diagnosed with Sweet‐like syndrome.ConclusionOur case highlights the uncommonly presented azathioprine‐induced Sweet‐like syndrome that occurs abruptly after the commencement of the offending drug. This diagnosis can be established through basic laboratory workup and skin biopsy findings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%