{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T02:21:37Z","timestamp":1788142897712,"version":"build-2803163510"},"reference-count":19,"publisher":"BMJ","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1991,6]]},"abstract":"<jats:p>Azathioprine hepatotoxicity has been described mainly in renal transplant recipients. Most reported cases are related to lesions of the venous system of the liver: peliosis hepatis, veno-occlusive disease of the liver, perisinusoidal fibrosis, and nodular regenerative hyperplasia of the liver. The most common clinical manifestation of these hepatic vascular lesions is portal hypertension. We present a case of nodular regenerative hyperplasia and perivenous fibrosis in a patient receiving azathioprine for multiple sclerosis. Histological abnormalities were similar to those described in renal transplant patients, and azathioprine was the only potential hepatotoxic agent present.<\/jats:p>","DOI":"10.1136\/gut.32.6.715","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"715-717","source":"Crossref","is-referenced-by-count":57,"title":["Azathioprine induced liver disease: nodular regenerative hyperplasia of the liver and perivenous fibrosis in a patient treated for multiple sclerosis."],"prefix":"10.1136","volume":"32","author":[{"given":"F","family":"Mion","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Napoleon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F","family":"Berger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Chevallier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Bonvoisin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Descos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1991,6,1]]},"reference":[{"issue":"168","key":"ref_1","first-page":"366","article-title":"The effect of Imuran and Azaserine on liver function tests in the dog","volume":"1967","author":"Haxhe, J.J.; Alexander, G.P.J.; Kestens, P.J.","unstructured":"Haxhe JJ, Alexander GPJ, Kestens PJ. The effect of Imuran and Azaserine on liver function tests in the dog. Arch Intern Phannacodyn 1967-168: 366-72.","journal-title":"Arch Intern Phannacodyn"},{"key":"ref_2","first-page":"139","article-title":"Liver disease in renal transplant recipients","volume":"64","author":"Sopko, J.; Anuras, S.","year":"1978","unstructured":"Sopko J, Anuras S. Liver disease in renal transplant recipients. AmJtMed 1978 64: 139-46.","journal-title":"AmJtMed"},{"key":"ref_3","first-page":"439","article-title":"Azathioprine and the liver. Evidence favoring idiosyncratic, mixed cholestatichepatocellular injury in humans. Gastroenterology 1984; 86: 4 Sparberg","volume-title":"Intrahepatic cholestasis due to azathioprine. Gastroenterology 1969; 57","author":"RA, De Pinho; CS, Goldberg; JH, Lefkowitch","unstructured":"De Pinho RA, Goldberg CS, Lefkowitch JH. Azathioprine and the liver. Evidence favoring idiosyncratic, mixed cholestatichepatocellular injury in humans. Gastroenterology 1984; 86: 4 Sparberg M, Simon N, Del Greco F. Intrahepatic cholestasis due to azathioprine. Gastroenterology 1969; 57: 439-41."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1136\/gut.19.8.748","article-title":"Peliosis hepatis in recipients of renal transplants","volume":"19","author":"Degott, C.; Rueff, B.; Kreis, H.; Duboust, A.; Potet, F.; Benhamou, J.P.","year":"1978","unstructured":"Degott C, Rueff B, Kreis H, Duboust A, Potet F, Benhamou JP. Peliosis hepatis in recipients of renal transplants. Gut 1978; 19: 748-53. Azathioprine induced liver disease","journal-title":"Gut"},{"key":"ref_5","first-page":"3699","article-title":"Hepatic sinusoidal dilatation with portal hypertension during azathioprine treatment: a cause of chronic liver disease after kidney transplantation","volume-title":"Transplant Proc","volume":"29","author":"Gerlag, P.G.G.; van Hooff, J.P.","year":"1987","unstructured":"Gerlag PGG, van Hooff JP. Hepatic sinusoidal dilatation with portal hypertension during azathioprine treatment: a cause of chronic liver disease after kidney transplantation. Transplant Proc 1987; 29: 3699-703."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/BF00429351","article-title":"Venoocclusive disease of the liver in patients receiving immunosuppressive therapy","volume":"395","author":"Weitz, H.; Gokel, J.M.; Loesche, K.; Possinger, K.; Eder, M.","year":"1982","unstructured":"Weitz H, Gokel JM, Loesche K, Possinger K, Eder M. Venoocclusive disease of the liver in patients receiving immunosuppressive therapy. Virchows Arch [A] 1982; 395: 245-56.","journal-title":"Virchows Arch [A]"},{"key":"ref_7","first-page":"446","article-title":"Azathioprine and hepatic veno-occlusive disease","volume-title":"renal transplanted patients. Gastroenterology 1986; 90","author":"Katzka, D.A.; Saul, S.H.; Jorkasky, D.; Sigal, H.; Reynolds, J.C.; Soloway, R.D.","unstructured":"Katzka DA, Saul SH, Jorkasky D, Sigal H, Reynolds JC, Soloway RD. Azathioprine and hepatic veno-occlusive disease in renal transplanted patients. Gastroenterology 1986; 90: 446-54."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1136\/gut.20.6.531","article-title":"Idiopathic portal hypertension (perisinusoidal fibrosis) after renal transplantation","volume":"20","author":"Nataf, C.; Feldmann, G.; Lebrec, D.","year":"1979","unstructured":"Nataf C, Feldmann G, Lebrec D, et al. Idiopathic portal hypertension (perisinusoidal fibrosis) after renal transplantation. Gut 1979; 20: 531-7.","journal-title":"Gut"},{"key":"ref_9","first-page":"256","article-title":"Role of endothelial cell injury in the spectrum of azathioprineinduced liver disease after renal transplant: light microscopy and ultrastructural observations","volume":"83","author":"Haboubi, N.Y.; Ali, H.H.; Whitwell, H.L.; Ackrill, P.","year":"1988","unstructured":"Haboubi NY, Ali HH, Whitwell HL, Ackrill P. Role of endothelial cell injury in the spectrum of azathioprineinduced liver disease after renal transplant: light microscopy and ultrastructural observations. Am J Gastroenterol 1988; 83: 256-61.","journal-title":"Am J Gastroenterol"},{"key":"ref_10","first-page":"331","article-title":"Is nodular regenerative hyperplasia of the liver associated with azathioprine therapy after renal transplantation?","volume":"3","author":"Jones, M.C.; Best, P.V.; Catto, G.R.D.","year":"1988","unstructured":"Jones MC, Best PV, Catto GRD. Is nodular regenerative hyperplasia of the liver associated with azathioprine therapy after renal transplantation? Nephrol Dial Transplant 1988; 3: 331-3.","journal-title":"Nephrol Dial Transplant"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1136\/bmj.1.5897.49","article-title":"Treatment of psoriasis with azathioprine","volume":"i:","author":"du Vivier A; DD, Munro; J, Verbov","year":"1974","unstructured":"du Vivier A, Munro DD, Verbov J. Treatment of psoriasis with azathioprine. BMJ 1974: i: 49-51.","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1212\/WNL.36.1.35","article-title":"Azathioprine toxicity in neuromuscular disease","volume":"36","author":"Kissel, J.T.; Levy, R.J.; Mendell, JR, Griggs; R.C.","year":"1986","unstructured":"Kissel JT, Levy RJ, Mendell JR, Griggs RC. Azathioprine toxicity in neuromuscular disease. Neurology 1986; 36: 35-9.","journal-title":"Neurology"},{"key":"ref_13","first-page":"3697","article-title":"Peliosis hepatis and nodular regenerative hyperplasia of the liver in renal transplants. Is cytomegalovirus the cause of this","volume-title":"severe disease? Transplant Proc","volume":"19","author":"Mourad, G.; Bories, P.; Berthelemy, C.; Barneon, G.; Michel, H.; Mion, C.","year":"1987","unstructured":"Mourad G, Bories P, Berthelemy C, Barneon G, Michel H, Mion C. Peliosis hepatis and nodular regenerative hyperplasia of the liver in renal transplants. Is cytomegalovirus the cause of this severe disease? Transplant Proc 1987; 19: 3697-8."},{"issue":"1","key":"ref_14","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1136\/ard.41.Suppl_1.44","article-title":"Rheumatoid arthritis: treatment with azathioprine (Imuran). Clinical side-effects and laboratory abnormalities","volume":"41","author":"Whisnant, J.K.; Pelkey, J.","year":"1982","unstructured":"Whisnant JK, Pelkey J. Rheumatoid arthritis: treatment with azathioprine (Imuran). Clinical side-effects and laboratory abnormalities. Ann Rheum Dis 1982; 41 (suppl 1): 44-7.","journal-title":"Ann Rheum Dis"},{"key":"ref_15","first-page":"495502","article-title":"Drug-induced vascular lesions of the liver","volume":"143","author":"Zafrani, E.S.; Pinaudeau, Y.; Dhumeaux, D.","year":"1983","unstructured":"Zafrani ES, Pinaudeau Y, Dhumeaux D. Drug-induced vascular lesions of the liver. Arch Intern Med 1983; 143: 495502.","journal-title":"Arch Intern Med"},{"key":"ref_16","first-page":"142","volume-title":"Antineoplastic agents and the liver. Gastroenterology 1980","volume":"78","author":"Menard, D.B.; Gisselbrecht, C.; Marty, M.; Reyes, F.; Dhumeaux, D.","unstructured":"Menard DB, Gisselbrecht C, Marty M, Reyes F, Dhumeaux D. Antineoplastic agents and the liver. Gastroenterology 1980; 78: 142-64."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1097\/00005792-198009000-00004","article-title":"Nodular regenerative hyperplasia of the liver in hematologic disorders: a possible response to obliterative portal venopathy. A morphometric study of 9 cases with an hypothesis on the pathogenesis","volume":"59","author":"Wanless, I.R.; Godwin, T.A.; Allen, F.; Feder, A.","year":"1980","unstructured":"Wanless IR, Godwin TA, Allen F, Feder A. Nodular regenerative hyperplasia of the liver in hematologic disorders: a possible response to obliterative portal venopathy. A morphometric study of 9 cases with an hypothesis on the pathogenesis. Medicine 1980; 59: 367-79.","journal-title":"Medicine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1001\/jama.1972.03210060044010","article-title":"Irreversible liver damage after azathioprine","volume":"222","author":"Zarday, Z.; Veith, F.J.; Gliedman, M.L.; Soberman, R.","year":"1972","unstructured":"Zarday Z, Veith FJ, Gliedman ML, Soberman R. Irreversible liver damage after azathioprine. JAMA 1972; 222: 690-1.","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/BF01300713","article-title":"Sclerosing hepatitis and azathioprine","volume":"31","author":"Barrowman, J.A.; Kutty, P.K.; Ra, M.U.; Huang, S.N.","year":"1986","unstructured":"Barrowman JA, Kutty PK, Ra MU, Huang SN. Sclerosing hepatitis and azathioprine. Dig Dis Sci 1986; 31: 221.","journal-title":"Dig Dis Sci"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.32.6.715","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T21:24:44Z","timestamp":1757280284000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.32.6.715"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1991,6]]},"references-count":19,"journal-issue":{"issue":"6","published-online":{"date-parts":[[1991,6,1]]},"published-print":{"date-parts":[[1991,6]]}},"alternative-id":["10.1136\/gut.32.6.715"],"URL":"https:\/\/doi.org\/10.1136\/gut.32.6.715","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1991,6]]}}}