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Abstract
We present a case of azathioprine hypersensitivity presenting as sepsis with elevated procalcitonin in a 68-year-old man with myasthenia gravis. The patient presented with fever, chills, nausea, vomiting, and headache. He developed numerous 1 cm erythematous papules over his upper torso. Infectious workup including bacteriological tests and microbial cultures was negative and a skin biopsy was performed which revealed suppurative folliculitis with eosinophils, consistent with drug hypersensitivity. Notably, acute phase reactants including C-reactive protein and procalcitonin were elevated upon presentation, likely secondary to drug hypersensitivity.
Highlights
Azathioprine is an immunosuppressant used in the treatment of various autoimmune conditions, including myasthenia gravis
A 68-year-old man who was diagnosed with myasthenia gravis three months prior to admission presented with acute nonpruritic painless 1 cm erythematous papules over the upper torso, accompanied with subjective fevers, chills, nausea, vomiting, and frontal headache for 2 days
Drug hypersensitivity syndrome (DHS) is often reported in patients treated with aromatic antiepileptic drugs and in rare cases with azathioprine [9]
Summary
Azathioprine is an immunosuppressant used in the treatment of various autoimmune conditions, including myasthenia gravis. Azathioprine immune hypersensitivity reaction is a rare adverse effect that has been reported in the literature relatively infrequently; the clinical presentation can often mimic sepsis [1, 2]. A review of case reports suggests that azathioprine-induced hypersensitivity reactions most commonly present with fever, chills, rigors, and/or gastrointestinal symptoms [1,2,3,4,5,6,7]. Clinicians should become familiar with the clinical presentation to recognize the symptoms and avoid early misdiagnosis
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