Azathioprine-induced Agranulocytosis and Severe Alopecia After Kidney Transplantation Associated With a NUDT15 Polymorphism: A Case Report

• Published in: Transplantation proceedings Vol. 50; no. 10; pp. 3925 - 3927
• Main Authors: Saida, K., Kamei, K., Ogura, M., Matsumura, S., Kano, Y., Sato, M., Andoh, A., Ishikura, K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2018
• Subjects: Adult; Agranulocytosis - chemically induced; Alopecia - chemically induced; Azathioprine - adverse effects; Female; Graft Rejection - prevention & control; Homozygote; Humans; Immunosuppressive Agents - adverse effects; Kidney Transplantation - methods; Polymorphism, Single Nucleotide - genetics; Pregnancy; Pyrophosphatases - genetics; Risk Factors
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2018.04.039

Azathioprine (AZA) is the drug recommended for the continuation of immunosuppressive treatment after renal transplant in women during pregnancy. A 37-year-old Japanese female developed agranulocytosis and severe alopecia after initiation of AZA (50 mg), used as an alternative to mycophenolate mofetil (MMF, 1000 mg) therapy in anticipation of a planned pregnancy. Within 4 days of the initiation of AZA therapy, the patient developed a high fever, leucopenia, and cranial alopecia. Genetic testing revealed a homozygous polymorphism of NUDT15 (rs116855232, NM_018283.3:c.415C>T: p.Arg139Cys), which has previously been identified as a risk factor for AZA-related complications in patients with inflammatory bowel disease. Genetic screening for NUDT15 could contribute to the prevention of serious adverse reactions to AZA and provide the opportunity for personalized medicine. Identification of a safe alternative to MMF during pregnancy after a renal transplant is a problem to be resolved in the future. •Azathioprine (AZA) is a relatively safe immunosuppressive drug during pregnancy.•Homozygous polymorphism of NUDT15 is a risk factor for AZA complications.•We describe a severe reaction to AZA in a patient administered a small dose of AZA.•Genetic testing provides an opportunity for personalized immunosuppressive treatment.