P2-20-2DIFFUSE LARGE B-CELL LYMPHOMA DURING AZATHIOPRINE THERAPY FOR AUTOIMMUNE HEPATITIS: A CASE REPORT

Abstract Introduction: Autoimmune hepatitis (AIH) is a form of chronic hepatitis of unknown aetiology. As for therapeutic agents, corticosteroids and azathioprine have been the standard therapy for AIH. On the other hand, immunosuppressant involving azathioprine may cause immunodeficiency - associated lymphoproliferative disorders (LPD). Herein, we report a case of diffuse large B-cell lymphoma (DLBCL) during azathioprine therapy for AIH. Case report: A 64-year-female was referred to our hospital because of epigastralgia on September 2013. She was diagnosed as having AIH 10 years previously, and since then she had been treated with corticosteroid alone, followed by steroid in combination with azathioprine. Physical examination revealed pale and anaemic conjunctivae. Endoscopic examination revealed an irregularly elevated mass in her antrum of stomach. Biopsy of the mass showed DLBCL. Because of uncontrollable bleeding, the patient underwent emergent gastrectomy. Pathological examination revealed EBER negativity; hence, it seemed that her disease course might have been poorer outcome. Then the patient was started on R-CHOP therapy and subsequently there were no evidence of relapse. Discussion: Azathioprine is among the immunosuppressive agents for various diseases such as Crohn's disease, systemic vasculitis, and systemic lupus erythematosus. And for AIH, azathioprine is recommended as a suitable treatment. As far as we know, only few cases of immunodeficiency - associated LPD following azathioprine therapy for AIH have been described. The frequency, clinical course and prognostic value of immunodeficiency-associated LPD associated AIH has not been clarified yet because of its rarity, and further accumulation of cases is necessary for evaluation of the therapeutic outcome of immunodeficiency - associated LPD patients.