Child Kidney Dis.  2017 Apr;21(1):35-39. 10.3339/jkspn.2017.21.1.35.

A Case of Azathioprine Induced Severe Myelosuppression and Alopecia Totalis in IgA Nephropathy

• Kim JC
• Kim YK
• Hyun HS
• Park EJ
• Kang HG
• Ha IS
• Cheong HI

• KMID: 2377567
• DOI: http://doi.org/10.3339/jkspn.2017.21.1.35

Abstract

Azathioprine is commonly used as immunosuppressive therapy for various inflammatory diseases including chronic glomerulonephritis. Myelosuppression is a common side effect of azathioprine, resulting in the need for dose reduction. However, severe pancytopenia or alopecia is not often encountered. Here, we report a case of severe myelosuppression, and alopecia totalis that occurred after azathioprine treatment in a patient with IgA nephropathy. A 10-year-old boy with IgA nephropathy was treated with oral deflazacort and later with azathioprine. After 4 weeks, the patient complained of hair loss, and despite a dose reduction in azathioprine, he developed bone marrow suppression and alopecia totalis in two weeks. The blood indices and alopecia of the patient had returned to normal after azathioprine withdrawal and 3 consecutive doses of granulocyte colony-stimulating factor. We suggest that physicians remain vigilant to the side effects of azathioprine. Unusual hair loss after azathioprine treatment might suggest a defect in the metabolism of the drug, warranting the discontinuation of azathioprine to prevent more severe side effects.

Keyword

Azathioprine; IgA nephropathy; Pancytopenia; Alopecia

MeSH Terms

Alopecia*
Azathioprine*
Bone Marrow
Child
Glomerulonephritis
Glomerulonephritis, IGA*
Granulocyte Colony-Stimulating Factor
Hair
Humans
Immunoglobulin A*
Male
Metabolism
Pancytopenia
Azathioprine
Granulocyte Colony-Stimulating Factor
Immunoglobulin A