Is it safe to continue azathioprine in a patient with severe bilateral panuveitis (thought to be related to sarcoidosis) and benign ethnic neutropenia, given worsening neutropenia since starting the medication, or should an alternative immunosuppressive agent be considered?

Patient with a history of presumed benign ethnic neutropenia: PMN 1.5 prior to azathioprine and 1.2 after starting. The patient has an intolerance to oral prednisone. Elevated LFTs limit methotrexate use.

Answer from: at Academic Institution

In this case, I would consider stopping azathioprine and switching to an alternative medication, such as an anti-TNF agent. Although not a large drop in the PMN, azathioprine is known to cause leukopenia, and in a patient with known neutropenia, extra precaution should be taken. In the case of uveit...

Comments

at UTMB Health
Yes, I agree with considering other agents. Howeve...

at Legacy Devers Eye Institute
Thank you for this comment. I agree with it. I hav...

Answer from: at Academic Institution

I think I would lean towards less neutropenic agents: DMARD MTX vs escalation to TNF. I could consider MMF or MFA but more leuko/neutropenia there. Even JAK would be safer if an appropriate CV candidate.

Answer from: at Community Practice

In a patient with presumed (as stated in the history provided; unclear how long the patient has been neutropenic) benign ethnic neutropenia who developed increasing neutropenia while on azathioprine for the treatment of bilateral panuveitis thought to be related to sarcoidosis, I would certainly con...

Comments

at Vanderbilt University Medical Center
In my experience, the one bone marrow I Dx was mul...

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Is it safe to continue azathioprine in a patient with severe bilateral panuveitis (thought to be related to sarcoidosis) and benign ethnic neutropenia, given worsening neutropenia since starting the medication, or should an alternative immunosuppressive agent be considered?

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