Azathioprine Hypersensitivity Presenting as Cardiogenic Shock and Sweet's Syndrome in a Patient with Microscopic Polyangiitis

• Published in: Internal Medicine Vol. 51; no. 14; pp. 1889 - 1892
• Main Authors: Turow, Arthur, Yong, Tuck Y, Fok, Jie Shen, Li, Jordan YZ
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01-01-2012
• Subjects: Aged; Antibodies, Antineutrophil Cytoplasmic - blood; antineutrophil cytoplasmic antibodies; Autoantibodies; azathioprine; Azathioprine - adverse effects; cardiogenic shock; Case reports; congestive heart failure; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - etiology; Exanthema; Female; Fever; Humans; Hypersensitivity; Immunosuppressive Agents - adverse effects; Intra-Aortic Balloon Pumping; Leukocytes (neutrophilic); microscopic polyangiitis; Microscopic Polyangiitis - complications; Microscopic Polyangiitis - drug therapy; Microscopic Polyangiitis - immunology; Shock; Shock, Cardiogenic - diagnosis; Shock, Cardiogenic - etiology; Shock, Cardiogenic - therapy; Sweet Syndrome - diagnosis; Sweet Syndrome - etiology; Sweet's syndrome
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.51.6962

Azathioprine hypersensitivity is a clinical syndrome which may manifest from isolated fever and rash to multi-organ failure. This rare condition is usually self-limiting following the discontinuation of azathioprine. Therefore, it is important to maintain a high index of clinical suspicion for hypersensitivity reactions with azathioprine therapy. We report a case of azathioprine hypersensitivity in a 69-year-old woman who developed cardiogenic shock and Sweet's syndrome following the initiation of azathioprine for her underlying autoantibodies to neutrophil cytoplasmic antigens (ANCA) associated microscopic polyangiitis.