Portale Hypertension unter Azathioprin bei Morbus Crohn - ein häufiges Phänomen?

HISTORY AND FINDINGS ON ADMISSION: A 45-year-old man with 18 years history of Crohn’s disease who was on treatment with azathioprine (AZA) for the past 48 months was admitted because of haematemesis and melaena. INVESTIGATIONS AND DIAGNOSIS: Tests showed a slight elevation of bilirubin and a low platelet count. Endoscopy revealed esophageal and gastric fundus varices. Magnetic resonance imaging (MRI) revealed severe portal vein hypertension with a spleen-kidney convolute of varices. Liver biopsy showed hyperplasia of hepatocytes and a reticular fibrosis, consistent with the diagnosis of nodular regenerative hyperplasia (NRH). TREATMENT AND COURSE: AZA treatment was stopped. The fundal varices were treated with endoscopic histoacryl injection. The patient is at present in good health and is followed up in our outpatient department. CONCLUSION: AZA as a widely used immunosuppressive drug has side effects in about 5 - 10 % of the cases. The risk of hepatotoxicity in patients treated with AZA is often underestimated. Therefore, physicians treating patients with inflammatory bowel disease have to be precocious regarding the increase of hepatic enzymes and pathologic signs in liver imaging in relation of AZA treatment. The latter might refer to NRH which would lead to severe portal vein hypertension.