Sedai Hari, Shrestha Suraj, Chand Vikash, Poddar Elisha, Acharya Suman, Koirala Dinesh
Maharajgunj Medical Campus, Institute of Medicine.
Departments of Internal Medicine.
Ann Med Surg (Lond). 2023 Apr 7;85(5):2059-2063. doi: 10.1097/MS9.0000000000000562. eCollection 2023 May.
Azathioprine (AZA) used as an immunomodulator agent in the management of inflammatory bowel disease (IBD) increases the risk of the development of lymphoma.
We present a case of a 45-year-old female receiving AZA for severe ulcerative colitis for 4 years. She presented with the chief complaints of bloody stool and abdominal pain for 1 month. Through a series of investigations including colonoscopy, contrast-enhanced computed tomography scan of the abdomen and pelvis, and biopsy with immunohistochemistry; she was diagnosed to have diffuse large B-cell lymphoma of the rectum. She is currently on a chemotherapeutic regimen and is planned for surgical resection after the completion of neoadjuvant therapy.
AZA is classified as a carcinogen by the International Agency for Research on Cancer. Prolonged exposure to higher doses of AZA increases the risk of developing lymphoma in IBD. Previous meta-analysis and research indicate that the risk of development of lymphoma after the use of AZA in IBD increases by about four- to six-fold, especially in older age groups.
AZA may increase the susceptibility to developing lymphoma in IBD, but the benefit far outweighs the risk. Precautions must be taken in prescribing AZA in older individuals which mandates periodic screening.
硫唑嘌呤（AZA）作为一种免疫调节剂用于治疗炎症性肠病（IBD），会增加淋巴瘤发生的风险。
我们报告一例45岁女性，因重度溃疡性结肠炎接受AZA治疗4年。她以便血和腹痛为主诉就诊1个月。通过一系列检查，包括结肠镜检查、腹部和盆腔增强CT扫描以及免疫组化活检；她被诊断为直肠弥漫性大B细胞淋巴瘤。她目前正在接受化疗方案治疗，并计划在新辅助治疗完成后进行手术切除。
AZA被国际癌症研究机构列为致癌物。长期暴露于较高剂量的AZA会增加IBD患者发生淋巴瘤的风险。先前的荟萃分析和研究表明，IBD患者使用AZA后发生淋巴瘤的风险增加约四至六倍，尤其是在老年人群中。
AZA可能会增加IBD患者发生淋巴瘤的易感性，但益处远大于风险。在为老年个体开具AZA时必须采取预防措施，这需要定期筛查。
