Chest
Volume 83, Issue 4, April 1983, Pages 696-698
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Journal Article
Azathioprine-Associated Pulmonary Dysfunction

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We present a case of azathioprine-associated alveolitis diagnosed by gallium-67 scanning and transbronchial biopsy. The patient denied respiratory symptoms, exhibited spiking fevers, and had normal chest roentgenograms. Allopurinol inhibition of azathioprine metabolism may have been a contributing factor.

Section snippets

CASE REPORT

A 35-year-old man was admitted for evaluation of intermittent fever (39.4°C). Crohn’s disease had been diagnosed when he was aged 17. Four bowel operations performed because of obstruction or fistulas resulted in an ileostomy in 1970. Subsequent medical therapy included a two-month trial of azulfidine because of radiologic demonstration of ileal recurrence two years prior to admission. Kidney stones were passed in 1971, 1972, and 1979. Stone analysis indicated 90 percent urate in each instance.

DISCUSSION

Azathioprine-associated pulmonary toxicity appears to be a rare occurrence. In a review of the literature we found two case reports presumptive of azathioprine-induced lung injury characterized by fever, dyspnea, and diffuse pulmonary infiltrates. Rubin et al4 described a patient with ulcerative colitis who received cyclophosphamide two months prior to beginning a six-week course of azathioprine (100 mg/day). Acute restrictive disease with decreased diffusion capacity was reported in a setting

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