Case Report
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 14, 2007; 13(34): 4646-4648
Published online Sep 14, 2007. doi: 10.3748/wjg.v13.i34.4646
Alcohol binging causes peliosis hepatis during azathioprine therapy in Crohn's disease
Christoph Elsing, Joerg Placke, Thomas Herrmann
Christoph Elsing, Department of Gastroenterology, St Elsiabeth Hospital Dorsten, Germany
Joerg Placke, Institute of Pathology and Cytology, Dinslaken, Germany
Thomas Herrmann, Department of Gastroenterology, University of Heidelberg, Heidelberg 69120, Germany
Author contributions: All authors contributed equally to the work.
Correspondence to: Thomas Herrmann, MD, Department of Gastroenterology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany. thomas_herrmann@med.uni-heidelberg.de
Telephone: +49-6221-5638725 Fax: +49-6221-5633642
Received: April 10, 2007
Revised: May 23, 2007
Accepted: May 31, 2007
Published online: September 14, 2007
Abstract

Patients with inflammatory bowel disease have normal life expectancy and, due to modern immunosuppressive therapies, also a normal quality of life. Since mostly young people are affected, their social behaviour suits this environment. Alcohol binging is an increasingly disturbing factor among young people. We describe a patient with Crohn’s disease, treated with azathioprine, who developed peliosis hepatis after three epsiodes of alcohol binging. Liver toxicity was not observed previously during the course of the treatment. Azathioprine-induced peliosis hepatis is thought to be idiosyncratic in humans. From animal studies, however, it is clear that hepatic depletion of glutathione leads to azathioprine toxicity to the sinusoidal endothelial cells. Damage of these cells causes peliosis hepatis. Since alcohol binging leads to hepatic glutathione depletion, we conclude that in our patient the episodes of binging have reduced liver gluathione content and therefore this has increased azathioprine toxicity causing peliosis hepatis. The problem of alcohol binging has not yet been addressed in IBD patients undertaking immunosuppressive therapy. This should be reviewed in future considerations regarding patients advice.

Keywords: Inflammatory bowel disease; Treatment; Side effects; Alcohol; Liver