Open AccessMultiple cutaneous neutropenic ulcers associated with azathioprine
Author(s) -
Baisakhi Laha,
Rajib Guha,
Avijit Hazra
Publication year - 2012
Publication title -
indian journal of pharmacology/the indian journal of pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.286
H-Index - 59
eISSN - 1998-3751
pISSN - 0253-7613
DOI - 10.4103/0253-7613.100405
Subject(s) - medicine , azathioprine , dermatology , surgery , debridement (dental) , leukopenia , nose , chemotherapy , disease
We report a case of neutropenic ulceration in a 42-year-old woman receiving azathioprine for pemphigus vulgaris. She developed multiple indolent ulcers involving the nose, neck, and back, after about 6-8 weeks following commencement of azathioprine 50 mg daily. The ulcers were large, disfiguring, dry, and with basal necrotic slough. They were painless and did not discharge pus. The absolute neutrophil count was severely depressed initially, but normalized following azathioprine withdrawal. Swab culture revealed colonization with Klebsiella pneumoniae and the ulcers healed with local debridement, treatment with imipenem, and topical application of mupirocin. However, nasal disfigurement persisted. Neutropenic ulceration is known to be associated with azathioprine therapy but we report this case because of the unusual presentation-indolent cutaneous ulcers. Early recognition of the problem and drug withdrawal can prevent complications like disfigurement.