Acute pancreatitis following azathioprine therapy of crohn's disease--a case report and the overview of the literature

Crohn's disease (CD) is the consequence of intestinal mucosa injury due to incorrect immune response to intestinal bacterial infection with lymphocyte T participation. Azathioprine--an immuno-modulator, is effective in the treatment and prevention of acute exacerbation of CD. It hinders the activity of immune cells, and therefore, the immune response. The use of azathioprine also reduces th necessity for corticosteroid therapy. Despite its efficacy, complications of azathioprine therapy are possible, including acute pancreatitis. In addition, acute pancreatitis is one of the extra-intestinal manifestations of acute exacerbation of CD without the previous use of azathioprine. We present a patient with acute pancreatitis, which occurred three weeks after the start of azathioprine treatment and manifested by clinical signs and symptoms similar to acute CD deterioration, and with elevated serum amylase and lipase levels. The symptoms responded rapidly to treatment with intravenous fluids, analgesics and azathioprine discontinuation after other possible causes were excluded. Thus, it is reasonable to estimate serum amylase and lipase levels frequently during 2 to 3 weeks after the start of azathioprine treatment for CD due to the possibility of acute pancreatitis occurring during this period in order to diagnose and treat acute pancreatitis as soon as possible, including early discontinuation of azathioprine therapy.