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Peer-reviewedCC BY-NC-ND 4.0ACG Case Reports Journal

Long-Term Follow-up of Azathioprine-Induced Portosinusoidal Vascular Disease in a Patient With Crohn's Disease

  • Foudhil Azizi1
  • Rachid Ouldgougam1
  • Youness Aouameur1
  • Salah Eddine Samy Bourezak1
  • Mourad Gasri2
  • Zine Charaf Amir3
  • Mohamed El Amine Boudjella1
  1. 1Department of Hepatology and Internal Medicine, Bologhine Ibn Ziri hospital, Algiers, Algeria
  2. 2Department of Radiology, Lamine Debaghine hospital, Algiers, Algeria
  3. 3Department of Pathology, Mustapha Pacha hospital, Algiers, Algeria
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Abstract

Azathioprine is widely used to treat inflammatory bowel disease, organ transplantation, and autoimmune disorders. Hepatotoxicity is a rare but serious complication. We report a 48-year-old man with ileocolonic Crohn’s disease who developed azathioprine-induced portosinusoidal vascular disease (PSVD) after 15 years of treatment. Diagnosis was suspected due to persistent cytopenia (leukopenia and thrombocytopenia) and when transabdominal ultrasonography and upper gastrointestinal endoscopy showed signs of portal hypertension. There was also an extensive portal thrombosis in the right portal vein, portal bifurcation, and origin of the left portal vein. Liver biopsy confirmed PSVD, showing nodular regenerative hyperplasia, sinusoidal dilation, and obliterative portal venopathy without cirrhosis. Treatment included azathioprine discontinuation, carvedilol, and anticoagulants. After 4 years of follow-up, Crohn's disease remained in deep remission, portal thrombosis recanalized, and portal hypertension stabilized. This case highlights the importance of monitoring for PSVD in long-term thiopurine users.

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Cite

BibTeXRIS
BibTeX
@article{azizi2026longterm,
  title = {{Long-Term Follow-up of Azathioprine-Induced Portosinusoidal Vascular Disease in a Patient With Crohn's Disease}},
  author = {Foudhil Azizi and Rachid Ouldgougam and Youness Aouameur and Salah Eddine Samy Bourezak and Mourad Gasri and Zine Charaf Amir and Mohamed El Amine Boudjella},
  journal = {ACG Case Reports Journal},
  year = {2026},
  month = nov,
  doi = {10.14309/crj.0000000000002387},
  url = {https://doi.org/10.14309/crj.0000000000002387},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Long-Term Follow-up of Azathioprine-Induced Portosinusoidal Vascular Disease in a Patient With Crohn's Disease
AU  - Foudhil Azizi
AU  - Rachid Ouldgougam
AU  - Youness Aouameur
AU  - Salah Eddine Samy Bourezak
AU  - Mourad Gasri
AU  - Zine Charaf Amir
AU  - Mohamed El Amine Boudjella
PY  - 2026
DA  - 2026/11/04
JO  - ACG Case Reports Journal
DO  - 10.14309/crj.0000000000002387
UR  - https://doi.org/10.14309/crj.0000000000002387
AB  - Azathioprine is widely used to treat inflammatory bowel disease, organ transplantation, and autoimmune disorders. Hepatotoxicity is a rare but serious complication. We report a 48-year-old man with ileocolonic Crohn’s disease who developed azathioprine-induced portosinusoidal vascular disease (PSVD) after 15 years of treatment. Diagnosis was suspected due to persistent cytopenia (leukopenia and thrombocytopenia) and when transabdominal ultrasonography and upper gastrointestinal endoscopy showed signs of portal hypertension. There was also an extensive portal thrombosis in the right portal vein, portal bifurcation, and origin of the left portal vein. Liver biopsy confirmed PSVD, showing nodular regenerative hyperplasia, sinusoidal dilation, and obliterative portal venopathy without cirrhosis. Treatment included azathioprine discontinuation, carvedilol, and anticoagulants. After 4 years of follow-up, Crohn's disease remained in deep remission, portal thrombosis recanalized, and portal hypertension stabilized. This case highlights the importance of monitoring for PSVD in long-term thiopurine users.
SN  - 2326-3253
ER  -