Erythema nodosum as azathioprine hypersensitivity reaction in a patient with bullous pemphigoid

Abstract

A 65-year-old woman with bullous pemphigoid presented with fever and several red-purple nodular subcutaneous lesions on both lower legs 1 week after starting treatment with azathioprine (AZA). Biopsy of a skin nodule was compatible with erythema nodosum (EN) and hypersensitivity reaction to AZA was suspected. AZA was subsequently discontinued, observing complete remission of fever and EN within 2 weeks. This case highlights the importance of recognizing EN as a possible manifestation of hypersensitivity reaction to AZA.

Keywords

• Azathioprine
• bullous pemphigoid
• erythema nodosum
• hypersensitivity syndrome