Managing Azathioprine-Induced Myelosuppression and Alopecia Totalis: Lessons from a Systemic Lupus Erythematosus Patient

This case report highlights the occurrence of severe myelosuppression and alopecia totalis in a 27-year-old female with systemic lupus erythematosus (SLE) following azathioprine (AZA) treatment. Initially treated with systemic steroids and then AZA, the patient developed significant hair loss and pancytopenia after increasing the AZA dose. Despite discontinuing AZA and treating with high-dose steroids and GM-CSF, her blood parameters were slow to improve. After switching to IV Rituximab, her condition improved, with blood counts normalizing and hair regrowth observed. The report emphasizes the importance of monitoring for early signs of myelosuppression, such as alopecia, in patients on AZA to manage these rare but serious side effects effectively.