BACKGROUND: Azathioprine [AZA] and mercaptopurine [MP] are recommended for maintenance of steroid-free remission in children with Crohn`s disease [CD]. Azathioprine-induced pancreatitis, an idiosyncratic and major side effect, has been considered as an absolute contraindication for the use of a second thiopurine in IBD patients. MATERIALS AND METHODS: We describe two children with CD in whom MP were successfully trialled after a confirmed azathioprine-induced pancreatitis, being well tolerated in both cases. RESULTS: Two boys [13 and 10 years old] started exclusive enteral nutrition after diagnosis of moderate (Pediatric Crohn's Disease Activity Index [wPCDAI] = 45) and mild [wPCDAI = 35] CD. Both developed an acute mild to moderate pancreatitis after 2 and 3 weeks, respectively, of AZA treatment but recovered fully in hospital after AZA withdrawal. They started on MP treatment without any adverse effect. They were tested for the presence of polymorphisms 238G>C, 460G>A, and 719A>G in the TPMT gene and 94C>A and 21>C in the ITPase. Both patients were wild-type for all tested polymorphisms. CONCLUSIONS: Azathioprine-induced acute pancreatitis should not be considered as an absolute contraindication for the use of MP. Further investigation is required to create a better understanding of the mechanism underlying the adverse events and to allow more possibilities for personalised therapy.

Department of Human Pharmacology and Toxicology Faculty of Pharmacy UVPS Brno Czech Republic

Department of Human Pharmacology and Toxicology Faculty of Pharmacy UVPS Brno Czech Republic Department of Clinical Pharmacy Hospital Pharmacy Faculty Hospital Brno Bohunice Czech Republic

Pediatric Gastroenterology and Nutrition Unit UGC de Pediatría Hospital Regional Universitario de Málaga Málaga Spain

Pediatric Gastroenterology and Nutrition Unit UGC de Pediatría Hospital Regional Universitario de Málaga Málaga Spain Biomedical Institute of Malaga [IBIMA] Hopsital General de Málaga Málaga Spain

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