Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Azathioprine-induced pulmonary haemorrhage in a child after renal transplantation

Abstract

We report a case of azathioprine-induced haemorrhagic alveolitis, in a 14-year-old boy, after renal transplantation. On day 25 the patient developed haemoptysis, fever and hypoxaemia. Chest X-ray showed diffuse reticulo-nodular shadows in both lung fields. Bronchoalveolar lavage samples were haemorrhagic and demonstrated a relative neutrophilia and a mild lymphocytosis, with a normal CD4/CD8 ratio. Azathioprine was discontinued on day 26. The patient required mechanical ventilation for 4 days. A positive leucocyte migration inhibition test and the recurrence of the symptoms after a second short course of azathioprine therapy suggested a cell-mediated mechanism. This patient is, to our knowledge, the first child to suffer from azathioprine-induced pulmonary haemorrhage.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Lockshin MD, Kagen LI (1972) Meningitic reaction after azathioprine. N Engl J Med 286:1321–1322

  2. 2.

    Farthing MJD, Coxon AY, Sheaff PC (1980) Polyneuritis associated with azathioprine therapy. BMJ 280:367

  3. 3.

    Bosh FH, Meinders AE (1985) General malaise, high fever and arthralgias as rare side effects of azathioprine. Ned Tijdschr Geneeskd 129:1593–1595

  4. 4.

    Cunningham T, Barraclough D, Muirden K (1981) Azathioprine-induced shock. BMJ 283:823–824

  5. 5.

    Major GAC, Moore P (1984) Acute hypersensitivity with profound circulatory collapse following exposure to azathioprine. Aust N Z J Med 14:371–372

  6. 6.

    Rosenthal E (1986) Azathioprine shock. Postgrad Med J 62: 677–678

  7. 7.

    Rubin G, Baume P, Vaudenberg (1972) Azathioprine and acute restrictive lung disease. Aust N Z J Med 2:272–274

  8. 8.

    Weissenburger DD (1978) Interstitial pneumonitis associated with azathioprine therapy. Am J Clin Pathol 69:181–185

  9. 9.

    Krowka MJ, Breuer RI, Kehoe TJ (1983) Azathioprine-associated pulmonary dysfunction. Chest 83:696–698

  10. 10.

    Carmichael DJS, Hamilton DV, Evans DB, Stovin PGI, Calne RY (1983) Interstitial pneumonitis secondary to azathioprine in a renal transplant patient. Thorax 38:951–952

  11. 11.

    Bedrossian CWM, Sussman J, Conklin RH, Kahan B (1984) Azathioprine-associated interstitial pneumonitis. Am J Clin Pathol 82:148–154

  12. 12.

    Brown AL, Corris PA, Ashcroft T, Wilkinson R (1992) Azathioprine-induced interstitial pneumonitis in renal transplant recipient. Nephrol Dial Transplant 7:362–364

  13. 13.

    Akoun G, Mayaud C, Touboul JL, Gauthier-Rahman S, El Gharbi N (1986) La pneumopathie d'hypersensibilité à l'azathioprine. Données en faveur d'un mécanisme immunologique. Therapie 41: 73–75

  14. 14.

    Foucher P, Pernichou M, Massin F, Coudert B, Sgro C, Escousse A, Jeannin L, Camus P (1989) Accidents respiratoires medicamenteux. Therapie 44:229–235

  15. 15.

    Gauthier-Rahman S, Morlat JL, Leca G, Bouin M (1982) A rapid photoelectric method for reading cell migration from agarose microdroplets. J Immunol Methods 53:77–89

  16. 16.

    Rahman SG, Akoun GH (1987) A rapid photoelectric method for reading human leucocytes migration. Clin Immunol Newslett 8: 36–38

  17. 17.

    Kahn FW, Jones JM, England DM (1987) Diagnosis of pulmonary haemorrhage in the immunocompromised host. Am Rev Respir Dis 136:155–160

  18. 18.

    Roland J, Valade S, Mayaud C, Antoine M (1989) Les hémorragies intra-alvéolaires chez les immundeprimés. Arch Anat Cytol Pathol 37:153–159

  19. 19.

    Bucknall C, Adamson M, Banham S (1987) Non fatal pulmonary haemorrhage associated with nitrofurantoin. Thorax 42:475–476

  20. 20.

    Grattan MT, Moreno-Cabral CE, Starnes VA, Oyer PE, Stinson EB, Shunmway NE (1989) Cytomegalovirus infection is associated with cardiac allograft rejection and atherosclerosis. JAMA 261:3561–3566

  21. 21.

    Sherman JM, Winnie G, Thomassen MJ, Abdul-karim FW, Boat TF (1984) Time course of hemosiderin production and clearance by human pulmonary macrophages. Chest 86:409–411

  22. 22.

    Kramer MS, Leventhal JM, Hutchinson TA, Feinstein AR (1979) An algorithm for the operational assessment of adverse drug reaction. JAMA 242:623–632

  23. 23.

    Danel C, Israel-Biet D, Costabel U, Rossi GA, Wallaert B (1990) Drug induced pneumonitis. Eur Respir J 3:952–954

Download references

Author information

Correspondence to Albert Bensman.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Refabert, L., Sinnassamy, P., Leroy, B. et al. Azathioprine-induced pulmonary haemorrhage in a child after renal transplantation. Pediatr Nephrol 9, 470–473 (1995). https://doi.org/10.1007/BF00866729

Download citation

Key words

  • Azathioprine
  • Pulmonary haemorrhage
  • Renal transplant