TY - JOUR
T1 - Azathioprine and 6-mercaptopurine-induced intrahepatic cholestasis of pregnancy
T2 - Case report and review of the literature
AU - Frank Wolf, Maya
AU - Sloma, Ronen
AU - Akria, Luiza
AU - Rimon, Eli
AU - Wiener, Yifat
AU - Carmiel Haggai, Michal
AU - Lowenstein, Lior
N1 - Publisher Copyright:
© 2023
PY - 2023/9
Y1 - 2023/9
N2 - Objective: Azathioprine, a prodrug of 6-mercaptopurine (6-MP), is used in the treatment of inflammatory bowel disease and may be continued during pregnancy. Acute cholestatic liver injury has been reported to occur with azathioprine. We aimed to examine azathioprine related cholestasis effect on pregnancy complications and outcome. Case report: We present a unique case of 6-MP-induced severe intrahepatic cholestasis of pregnancy (ICP) that required meticulous combined therapy including plasma exchange. The symptoms resolved following 6-MP withdrawal. A literature review revealed 11 pregnancies complicated by early-induced severe ICP among women treated with azathioprine or 6-MP. Conclusion: We recommend weekly bile acid level tests for pregnant women treated with azathioprine or 6-MP, beginning early in the second trimester of pregnancy, and the prompt discontinuation of treatment upon establishment of an ICP diagnosis.
AB - Objective: Azathioprine, a prodrug of 6-mercaptopurine (6-MP), is used in the treatment of inflammatory bowel disease and may be continued during pregnancy. Acute cholestatic liver injury has been reported to occur with azathioprine. We aimed to examine azathioprine related cholestasis effect on pregnancy complications and outcome. Case report: We present a unique case of 6-MP-induced severe intrahepatic cholestasis of pregnancy (ICP) that required meticulous combined therapy including plasma exchange. The symptoms resolved following 6-MP withdrawal. A literature review revealed 11 pregnancies complicated by early-induced severe ICP among women treated with azathioprine or 6-MP. Conclusion: We recommend weekly bile acid level tests for pregnant women treated with azathioprine or 6-MP, beginning early in the second trimester of pregnancy, and the prompt discontinuation of treatment upon establishment of an ICP diagnosis.
KW - Azathioprine
KW - Bile acids and salts
KW - Intrahepatic cholestasis of pregnancy
KW - Mercaptopurine
KW - Plasma exchange
UR - http://www.scopus.com/inward/record.url?scp=85165307519&partnerID=8YFLogxK
U2 - 10.1016/j.tjog.2023.07.023
DO - 10.1016/j.tjog.2023.07.023
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C2 - 37679010
AN - SCOPUS:85165307519
SN - 1028-4559
VL - 62
SP - 761
EP - 764
JO - Taiwanese Journal of Obstetrics and Gynecology
JF - Taiwanese Journal of Obstetrics and Gynecology
IS - 5
ER -