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• W4366083873 abstract "To the Editor, Azathioprine [AZA], widely administered as maintenance therapy for Crohn’s disease [CD], is known to have various adverse effects. Recently, cases of AZA-related non-cirrhotic portal hypertension [PH] have been reported, though its occurrence is considered to be rare.1,2 Herein, we report a case of AZA-related porto-sinusoidal vascular disease [PSVD]3 in a patient with CD diagnosed 7 years after beginning AZA administration. A 44-year-old male was diagnosed with ileocolonic CD ~20 years previously. Eight years after that diagnosis, severe stenosis of the terminal ileum developed and an ileocecal resection was performed. Infliximab administration was started, though abdominal pain and diarrhoea appeared approximately 2 years later. Thus, administration of AZA was commenced 3 years after the resection procedure. Approximately 7 years after beginning AZA, severe stenosis of the neo-terminal ileum was revealed. Oesophagogastroduodenoscopy performed as a preoperative examination showed oesophageal varices [EVs] with red colour signs [Figure 1A]. Hepatobiliary enzymatic activities were nearly normal, with no abnormal findings indicating potential chronic liver injury. However, only platelet count gradually decreased from 36.5 × 104 to 10.5 × 104/μL during the approximately 7-year period after starting AZA administration. Additionally, a review of previous abdominal computed tomography images demonstrated splenomegaly with gradual enlargement over time during the same period. As these findings were suggestive of PH, a parenchymal liver biopsy was performed. Histological findings demonstrated dilated sinusoids and mild fibrotic findings from the central vein to portal vein area [Figure 1D–G], suggesting PSVD. No evidence of cirrhotic change of the liver was found. It was considered that PSVD might have been caused by AZA-induced sinusoidal endothelial cell injury, because of the rapid platelet count decrease and splenomegaly after beginning AZA treatment. Thus, administration of AZA was discontinued. Endoscopic therapy for EV contributed to complete eradication [Figure 1B]. To treat the neo-terminal ileum stenosis, a small partial intestinal resection was performed. Two years after discontinuation of AZA, oesophagogastroduodenoscopy revealed EV recurrence [Figure 1C], indicating the existence of prolonged PH even after AZA discontinuation." @default.
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• W4366083873 date "2023-04-17" @default.
• W4366083873 modified "2023-10-02" @default.
• W4366083873 title "Azathioprine-Induced Porto-Sinusoidal Vascular Disease Complicated with Oesophageal Varices in a Crohn’s Disease Patient – Case Report" @default.
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• W4366083873 doi "https://doi.org/10.1093/ecco-jcc/jjad066" @default.
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