mercaptopurine and Hyperplasia

Nodular regenerative hyperplasia (NRH) has been associated with thiopurine therapy in patients with inflammatory bowel disease (IBD), but prevalence and prognosis of NRH remain unclear. This study is a cross-sectional search for NRH in IBD patients with long-term azathioprine or 6-mercaptopurine treatment.. Thirty-three IBD patients with continuous azathioprine/6-mercaptopurine treatment for at least 5 years were included. Laboratory tests, thiopurine metabolite levels, liver histology, MRI were examined for NRH and signs of portal hypertension.. NRH was not observed in this cohort of 33 patients. Nevertheless, some possibly related signs of vascular changes were found by MRI in three patients. Also, splenomegaly, which may be associated with portal hypertension, was found in one patient. No high thiopurine dose neither high metabolite levels were found in these patients.. No NRH was found in this group of IBD patients with long-term azathioprine/6-mercaptopurine treatment. Larger multicenter studies are needed to determine the prevalence of NRH in thiopurine-treated IBD patients.

Topics: Azathioprine; Chronic Disease; Cross-Sectional Studies; Humans; Hyperplasia; Hypertension, Portal; Inflammatory Bowel Diseases; Mercaptopurine; Prevalence

Topics: Adolescent; Adult; Aged; Azathioprine; Female; Humans; Hyperplasia; Inflammatory Bowel Diseases; Liver Diseases; Male; Mercaptopurine; Middle Aged; Thioguanine; Young Adult

Immunomodulator therapy with thiopurine analogues azathioprine or 6-mercaptopurine is commonly prescribed for the treatment of organ transplantation, inflammatory bowel disease, autoimmune diseases and malignancies. Hepatotoxicity due to thiopurine analogues usually presents as an increase in serum transaminase levels. Toxicity is usually not severe, and a dose reduction is effective in most patients. Nodular regenerative hyperplasia (NRH) is a very rare but potentially severe complication of thiopurine-containing therapy. NRH is often asymptomatic, neither biochemical nor molecular markers are indicative for NRH. The suspicion rises when there are clinical symptoms of portal hypertension or increases in transaminases levels orthrombocytopenia. Liver biopsy is essential for definitive diagnosis. This is a case report of a 40-year-old male patient with Crohn's disease who developed increased serum levels of liver enzymes and thrombocytopenia following the administration of thiopurine. Although treatment with thiopurine was discontinued, he has further progressed and presented with acute variceal bleeding due to portal hypertension. The diagnosis of nodular regenerative hyperplasia was proven by a liver biopsy. In conclusion, NRH is a very rare but potentially severe complication of thiopurine-containing immunosuppressive therapy for IBD.

Topics: Adult; Chemical and Drug Induced Liver Injury; Crohn Disease; Disease Progression; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Hyperplasia; Hypertension, Portal; Immunosuppressive Agents; Male; Mercaptopurine; Thrombocytopenia

Nodular regenerative hyperplasia (NRH) and sinusoidal dilatation have been described in relation to thiopurine use in patients with inflammatory bowel disease (IBD). However, there is a dearth of data on the prevalence of these histological abnormalities in general. The aim of our study was to describe the prevalence of these histological liver changes in a thiopurine-naïve IBD cohort.. Liver biopsy specimens were obtained from patients who were treated in a referral center and who underwent gastrointestinal surgery for IBD. Patients were excluded if thiopurines were ever used. The liver specimens were pathohistologically assessed with special attention to NRH.. A total of 83, properly stained, liver specimens (Crohn's disease 61%) were evaluated. NRH was observed in 6% compared to sinusoidal dilatation of varying degree in 34% of specimens. An older age at biopsy was correlated with NRH (p=0.015). Fibrosis and steatosis of varying degrees were detected in 31% and 36% of liver biopsies, respectively. No cases of liver cirrhosis were observed.. Pathohistological hepatic abnormalities are common in non-thiopurine using IBD patients. The association between thiopurine use, NRH and sinusoidal dilatation may be weaker than as reported in recent literature, as there is relatively high background prevalence in selected series.

Topics: Adolescent; Adult; Aged; Azathioprine; Biopsy, Needle; Female; Humans; Hyperplasia; Immunosuppressive Agents; Inflammatory Bowel Diseases; Liver; Male; Mercaptopurine; Middle Aged

Topics: Adolescent; Adult; Age Factors; Aged; Blood Platelets; Blood Transfusion; Cytarabine; Daunorubicin; Female; Humans; Hydrazines; Hyperplasia; Leukemia, Myeloid; Leukocyte Count; Leukopenia; Male; Mercaptopurine; Methotrexate; Middle Aged; Remission, Spontaneous; Thrombocytopenia; Time Factors

Topics: Adolescent; Adult; Azathioprine; Basement Membrane; Biopsy; Chloroquine; Cyclophosphamide; Female; Follow-Up Studies; Glomerulonephritis; Glucocorticoids; Humans; Hyperplasia; Kidney Glomerulus; Lupus Erythematosus, Systemic; Male; Mercaptopurine; Nephritis; Prednisolone