AZATHIOPRINE-INDUCED PULMONARY HEMORRHAGE IN A CHILD AFTER RENAL-TRANSPLANTATION

We report a case of azathioprine-induced haemorrhagic alveolitis, in a 14-year-old boy, after renal transplantation. On day 25 the patient d eveloped haemoptysis, fever and hypoxaemia, Chest X-ray showed diffuse reticulo-nodular shadows in both lung fields, Bronchoalveolar lavage samples were haemorrhagic and demonstrated a relative neutrophilia and a mild lymphocytosis, with a normal CD4/CD8 ratio. Azathioprine was d iscontinued on day 26. The patient required mechanical ventilation for 4 days. A positive leucocyte migration inhibition test and the recurr ence of the symptoms after a second short course of azathioprine thera py suggested a cell-mediated mechanism. This patient is, to our knowle dge, the first child to suffer from azathioprine-induced pulmonary hae morrhage.