Correspondence to Author: Parveen Malhotra, Harman Singh, Abhishek Yadav, Avani Sharma, Sandeep Kumar, Rahul Siwach, Pranav Malhotra, Anuj Sharma. 

Department of Medical Gastroenterology, PGIMS, Rohtak, Haryana, VMMC & Safdarjung Hospital, New Delhi, India.

DOI: 10.52338/jjogastro.2026.5355

Abstract:

Introduction: Azathioprine (AZA)-induced pancreatitis (AIP) is a known, though relatively uncommon, idiosyncratic drug reaction causing inflammation of the pancreas, often seen in patients with Inflammatory Bowel Disease (IBD) (Crohn's/UC) or autoimmune conditions, manifesting as abdominal pain, nausea, and vomiting, typically resolving quickly after stopping the drug but requiring medical attention for diagnosis and management. It's an unpredictable reaction, not strictly dose-dependent, linked to certain genetic markers (HLA alleles), and emphasizes the need for monitoring when using AZA.
Case report: We report a case of fifty-two-year-old female, a known case of--- on dermatological follow up and was started on tablet azathioprine 50 mg twice daily after food for last six months. She suddenly presented with acute pain abdomen which was epigastric and radiated to back. On evaluation, serum amylase and lipase were massively raised, leukocytosis, mild transaminitis but renal function test, complete lipid profile, blood sugar was normal and viral screen was negative. The ultrasonogram abdomen showed bulky pancreas with overlying intestine dilated with gaseous distension. The computed tomography abdomen done on 5th day revealed mild interstitial pancreatitis with CTSI score of 6/10. She was managed symptomatically with analgesics, antibiotics, intravenous fluid and other supportive therapy. After one week, she was discharged under hemodynamically stable condition and was pain free, passing normal stools and accepting orally well. There was no other risk factor identified for pancreatitis. She was advised not to take azathioprine and after regular follow up for last two years, she is totally asymptomatic without any kind of symptoms.
Conclusion: Azathioprine is used in patients with complex dermatologic conditions and/or resistant to conventional treatments. It has been approved for diseases like lupus, dermatomyositis, and pemphigus vulgaris. Thus, dermatologist should adequately educate the patient receiving azathioprine about its adverse effects and themselves remain vigil about these undesired effects which improve and resolve when azathioprine is decreased or interrupted. It is always recommended to start at the lowest possible dose in order to improve tolerance and to avoid permanent discontinuation of a drug that can be extremely beneficial for the patient.

Keywords: Pancreatitis, Azathioprine, Computed tomography scan, Amylase, Lipase .

Citation:

Dr. Parveen Malhotra, Azathioprine Induced Pancreatitis - An Uncommon Phenomenon. Japanese Journal of Gastroenterology 2026.