Severe Alopecia Caused by Azathioprine in Systemic Lupus Erythematosus

A 45-year-old female with stable systemic lupus erythematosus (SLE) experienced severe alopecia and leukopenia after switching to azathioprine (AZA) from mycophenolate mofetil. Initially, she was on mycophenolate mofetil and hydroxychloroquine, but due to stable disease, AZA was introduced. After 6 weeks, she developed severe leukopenia and alopecia, attributed to AZA-induced bone marrow suppression. AZA was discontinued, and her previous medication was resumed, leading to recovery of blood counts and hair regrowth over 3 months. This case highlights the importance of recognizing AZA's potential adverse effects, such as bone marrow suppression and hair loss, in SLE treatment.