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New onset of atrial fibrillation after introduction of azathioprine in ulcerative colitis: case report and review of the literature

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Abstract

Case report

We present the case of a 52-year-old man with steroid-dependent ulcerative colitis, needing immunosuppressive therapy with azathioprine. The drug had been started 3 years earlier, but stopped after a few months because the patient reported palpitations, lipothymia, nausea and vomiting. Given the continued steroid-dependent ulcerative colitis and the lack of clinical documentation about a reaction with a dubious relationship to azathioprine, we decided to rechallenge the patient with the drug under clinical monitoring and after informed consent.

After starting 50 mg of azathioprine, the patient showed general malaise, nausea and vomiting. An ECG showed atrial fibrillation, and the patient reported that the symptoms were similar to those previously experienced.

Discussion

We have found two other cases of similar onset of atrial fibrillation after azathioprine use, although some confounding elements in these episodes make the possible causal relationship between the drug and this adverse event uncertain.

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Acknowledgements

We are grateful to Mrs Mary Trotter for the English revision of this manuscript, and to Mrs Tiziana Arosio for her bibliographic assistance.

All authors declare they have no conflict of interest for this publication. No funding source contributed to the presentation of this manuscript.

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Authors and Affiliations

  1. Department of Clinical Science, Gastroenterology Unit, L. Sacco University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy

    Andrea Cassinotti, Alessandro Massari, Elisa Ferrara, Salvatore Greco, Matteo Bosani, Sandro Ardizzone & Gabriele Bianchi Porro

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  1. Andrea Cassinotti
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  2. Alessandro Massari
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  3. Elisa Ferrara
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  4. Salvatore Greco
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  5. Matteo Bosani
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  6. Sandro Ardizzone
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  7. Gabriele Bianchi Porro
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Correspondence to Andrea Cassinotti.

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Cassinotti, A., Massari, A., Ferrara, E. et al. New onset of atrial fibrillation after introduction of azathioprine in ulcerative colitis: case report and review of the literature. Eur J Clin Pharmacol 63, 875–878 (2007). https://doi.org/10.1007/s00228-007-0328-y

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  • DOI: https://doi.org/10.1007/s00228-007-0328-y

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