Azathioprine-Induced Liver Injury in a Patient with Multiple Autoimmune Syndrome

In a 2010 case report, a 39-year-old man with multiple autoimmune syndrome, which included alopecia areata, vitiligo, and ulcerative colitis, developed liver injury after being treated with azathioprine (AZA). The patient, who had been admitted for ulcerative colitis symptoms, initially received mesalazine but had to discontinue it due to intolerance. Subsequently, he was treated with a combination of AZA and prednisone. Following the initiation of AZA therapy, his liver enzymes increased significantly, signaling liver injury. The liver enzymes normalized two months after AZA was discontinued, and the patient continued on prednisone. The case report highlights the potential for increased risk of AZA-induced liver injury in patients with multiple autoimmune syndrome and suggests that antioxidants may mitigate this risk. It also points out that while treatments like sulfasalazine, corticosteroids, and TNF inhibitors can be beneficial for UC patients with extraintestinal manifestations, caution is advised when using AZA due to its hepatotoxicity. The authors declared no conflicts of interest.