Long-Term Follow-up of Azathioprine-Induced Portosinusoidal Vascular Disease in a Patient With Crohn's Disease
Foudhil Azizi, Rachid Ouldgougam, Youness Aouameur, Salah Eddine Samy Bourezak, Mourad Gasri, Zine Charaf Amir, Mohamed El Amine BoudjellaABSTRACT
Azathioprine is widely used to treat inflammatory bowel disease, organ transplantation, and autoimmune disorders. Hepatotoxicity is a rare but serious complication. We report a 48-year-old man with ileocolonic Crohn’s disease who developed azathioprine-induced portosinusoidal vascular disease (PSVD) after 15 years of treatment. Diagnosis was suspected due to persistent cytopenia (leukopenia and thrombocytopenia) and when transabdominal ultrasonography and upper gastrointestinal endoscopy showed signs of portal hypertension. There was also an extensive portal thrombosis in the right portal vein, portal bifurcation, and origin of the left portal vein. Liver biopsy confirmed PSVD, showing nodular regenerative hyperplasia, sinusoidal dilation, and obliterative portal venopathy without cirrhosis. Treatment included azathioprine discontinuation, carvedilol, and anticoagulants. After 4 years of follow-up, Crohn's disease remained in deep remission, portal thrombosis recanalized, and portal hypertension stabilized. This case highlights the importance of monitoring for PSVD in long-term thiopurine users.