Aplastic anemia secondary to azathioprine in systemic lupus erythematosus: report of a case with normal thiopurine S-methyltransferase enzyme activity and review of the literature

Lupus. 2013 Dec;22(14):1526-8. doi: 10.1177/0961203313504636. Epub 2013 Sep 12.


Azathioprine-induced aplastic anemia and fatal myelosuppression is a rare occurrence in patients with systemic lupus erythematosus (SLE). We report a case of a 53-year-old female with a normal thiopurine S-methyltransferase (TPMT) level who developed aplastic anemia within 4 weeks of azathioprine initiation, resulting in death. Physicians should be vigilant in monitoring routine blood work when administering azathioprine, a relatively common drug, in patients with SLE.

Keywords: Systemic lupus erythematosus; azathioprine; hematologic changes; musculoskeletal.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Anemia, Aplastic / chemically induced*
  • Anemia, Aplastic / physiopathology
  • Azathioprine / adverse effects*
  • Azathioprine / therapeutic use
  • Fatal Outcome
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use
  • Lupus Erythematosus, Systemic / drug therapy*
  • Methyltransferases / metabolism
  • Middle Aged


  • Immunosuppressive Agents
  • Methyltransferases
  • thiopurine methyltransferase
  • Azathioprine