Azathioprine-related Pancreatitis in a Patient with Crohn`s Disease: A Rare but Important Side Effect!

Background: Drug-Induced pancreatitis is not common in the pediatric population.Commoner causes of pancreatitisinclude viral infections or abdominal trauma especially from bicycle handle-bar accidents.

Objective: We present a 14 year old patient with Crohn`s disease who was started on azathioprine (AZA) for disease control.Hedeveloped epigastric pain with vomiting within one week of initiation of AZA.Initial concerns were that of mild gastritis: but as the abdominal pain persisted despite analgesia, we hunted for more pathological causes of the worsening abdominal pain.

Results: Blood results were consistent with evidence of pancreatitis and a corresponding ultrasound scan showed peri-pancreatic fluid with a bulky pancreas.AZA was stopped and the patient recovered well subsequently.He was started on methotrexate for Crohn`s disease subsequently.

Conclusion: AZA-induced pancreatitis is an unpredictable and dose-independent adverse event affecting less than 10% of patients with inflammatory bowel disease (IBD) patients treated with azathioprine. Most patients using AZA still have commoner side effects such asbone marrow suppression, gastrointestinal disturbance or hair loss.To prevent the serious consequences of pancreatitis, the future may hold better prospects by using genotype-guided therapy for initiation of AZA to risk stratify patients better.