{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:32:39Z","timestamp":1779237159847,"version":"3.51.4"},"reference-count":16,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2014,11,18]]},"abstract":"<jats:p>Azathioprine is an immunosuppressive medication used in the management of many autoimmune conditions. Commonly reported adverse effects from azathioprine therapy are nausea and bone marrow suppression, while less common side effects include hepatotoxicity. We present the case of a 47-year-old man with a history of myasthenia gravis on azathioprine for 1\u2005year, who presented to our institution with painless jaundice. On initial laboratory evaluation, the level of aspartate aminotransferase, alanine aminotransferase and total bilirubin were markedly elevated. Owing to the potential diagnosis of acute liver failure secondary to azathioprine toxicity, this medication was discontinued. A liver biopsy demonstrating drug-induced liver injury, along with high serum levels of 6-methylmercaptopurine nucleotide confirmed the diagnosis of azathioprine-induced hepatotoxicity. Upon discontinuation of the medication, the patient's transaminases and bilirubin levels improved steadily over the four-day hospital course. This case emphasises azathioprine's potential for hepatotoxicity, even 1\u2005year after the initiation of its use.<\/jats:p>","DOI":"10.1136\/bcr-2014-206859","type":"journal-article","created":{"date-parts":[[2014,12,3]],"date-time":"2014-12-03T09:08:05Z","timestamp":1417597685000},"page":"bcr2014206859","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Azathioprine-induced hepatitis and cholestasis occurring 1\u2005year after treatment"],"prefix":"10.1136","volume":"2014","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0572-5778","authenticated-orcid":false,"given":"Jason","family":"Chertoff","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabikha","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Black","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Islam Y","family":"Elgendy","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,12,3]]},"reference":[{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0399-8320(05)82136-0"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.2","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199606270-00019"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.3","doi-asserted-by":"publisher","DOI":"10.1177\/8755122513504078"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.4","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-010-9443-4"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.5","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2010.214"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01187.x"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.7","doi-asserted-by":"crossref","first-page":"95","DOI":"10.2165\/00044011-200019010-00010","article-title":"Hepatocanalicular cholestasis after 24 years of azathioprine administration for myasthenia gravis","volume":"19","author":"Muszkat","year":"2000","journal-title":"Clin Drug Investig"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.8","doi-asserted-by":"publisher","DOI":"10.1136\/gut.32.6.715"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(01)00196-9"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.10","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.56.654.274"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.11","doi-asserted-by":"publisher","DOI":"10.1081\/IPH-51744"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.12","first-page":"444","article-title":"Myelotoxicity and hepatotoxicity during azathioprine therapy","volume":"63","author":"de Boer","year":"2005","journal-title":"Neth J Med"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2004.00543.x"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.14","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.64.758.950"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.15","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2011-0214-OA"},{"key":"2025082704050987000_2014.dec03_1.bcr2014206859.16","first-page":"5810","article-title":"Differing contribution of thiopurine methyltransferase to mercaptopurine versus thioguanine effects in human leukemic cells","volume":"61","author":"Dervieux","year":"2001","journal-title":"Cancer Res"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2014-206859","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T11:05:17Z","timestamp":1756292717000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2014-206859"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,12,3]]},"references-count":16,"alternative-id":["10.1136\/bcr-2014-206859"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2014-206859","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,12,3]]}}}