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Gastroenterology Review/Przegląd Gastroenterologiczny
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Infliximab treatment in a paediatric patient with ulcerative colitis, who developed acute pancreatitis due to azathioprine during follow-up

Ahmet Basturk, Aygen Yilmaz, Meryem Keceli, Reha Artan

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Pancreatitis is histologically defined as inflammation of the pancreatic parenchyma. Acute pancreatitis is a disorder manifested by interstitial oedema, acute decrease in inflammatory cells, apoptosis, necrosis, and reversible improvement in haemorrhage [1]. Azathioprine (AZA) is among the drugs associated with acute pancreatitis, although encountered rarely. Our objective is to present a paediatric case with ulcerative colitis (UC), who developed acute pancreatitis during AZA treatment, and was treated (after the discontinuation of azathioprine) with infliximab due to the relapse of UC.
A 17-year-old paediatric patient applied to us with complaints of bloody stool, diarrhoea, abdominal pain, and weight loss, which emerged in the previous 2 months. Medical and familial history was normal. In the physical examination, height was measured as 168 cm (10–25 p), body weight 49 kg (< 3 p), no mouth ulcers were observed, and bilateral sensitivity in the abdomen and increased bowel sounds were recorded. No anal abscess, fistula, or fissure were observed during the anal examination. Laboratory analysis revealed: haemoglobin (Hb) 11 g/dl, leukocyte count (WBC) 13,500/mm3, platelet count (PLT) 478,000/mm3, alanine aminotransferase (ALT) 28 U/l (N: 0-40), aspartate aminotransferase (AST) 32 U/l (N: 0-41), γ-glutamyl transferase (GGT) 24 U/l (N: 0–61), total bilirubin (T.bil.) 0.9 mg/dl (N: 0–0.9), direct bilirubin (D.bil.) 0.2 mg/dl (N: 0–0.2), prothrombin time (PT) 14.6 s (N: 11–14), international normalised ratio (INR) 1.1 (N: 0.9–1.2), activated partial thromboplastin time (aPTT) 26.1 s (N: 25–33), albumin 4.2 g/dl, and faecal occult blood (HHb) 234. Stool culture was negative. Rotavirus, adenovirus and Entamoeba histolytica antigens were also negative. The upper endoscopy, which was carried out due to suspected inflammatory bowel disease, displayed antral gastritis and mild duodenitis, which was confirmed with histopathological analysis. In the colonoscopy, aphthous ulcerative areas were observed in the rectum, sigmoid colon, and caecum. The results of the multiple biopsies were interpreted in favour of ulcerative colitis. Methylprednisolone treatment, which was initiated with a loading dose of 2 mg/kg b.w./day, was planned for 6 weeks. Mesalazine 30 mg/kg b.w./day was concomitantly initiated. Azathioprine was started with a dose of 0.5 mg/kg b.w./day, and then the dose was increased to 2 mg/kg b.w./day. For the exacerbation periods, which...

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