Severe cholestasis due to azathioprine in Behcet's disease

BMJ Case Rep. 2019 Mar 31;12(3):e226340. doi: 10.1136/bcr-2018-226340.


Azathioprine (AZA) is an immunosuppressive drug that is widely used in the treatment of autoimmune diseases. Although AZA is used widely, many studies reported that AZA-related hepatotoxicity is rather rare. We aimed to present a case with severe cholestatic hepatitis due to AZA use for Behcet's disease. Three weeks after starting AZA for the treatment of uveitis, the patient was admitted to our clinic with cholestasis and constitutional symptoms. In liver biopsy, findings were in accordance with drug reaction, and the AZA treatment was stopped. After 2 months, bilirubin levels and liver tests results became normal. As a result, given that AZA may cause severe cholestasis, the drug should be stopped if idiosyncrasy or hypersensitivity develops. If there is a debate in the diagnosis, histopathological evaluation of the liver would be the major issue because of the correct diagnosis of the drug toxicity and excluding other aetiologies.

Keywords: drug interactions; drugs: gastrointestinal system; hepatitis other.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Azathioprine / adverse effects*
  • Azathioprine / therapeutic use
  • Behcet Syndrome / complications
  • Behcet Syndrome / drug therapy*
  • Behcet Syndrome / physiopathology
  • Chemical and Drug Induced Liver Injury
  • Cholestasis / chemically induced*
  • Cholestasis / drug therapy
  • Cholestasis / pathology
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use
  • Jaundice / chemically induced
  • Liver / drug effects
  • Liver / pathology*
  • Male
  • Nausea / chemically induced
  • Pruritus / chemically induced*
  • Pruritus / drug therapy
  • Pruritus / pathology
  • Treatment Outcome
  • Uveitis / drug therapy*
  • Uveitis / etiology
  • Vomiting / chemically induced


  • Immunosuppressive Agents
  • Azathioprine