Shingles during the course of treatment with 6-mercaptopurine for inflammatory bowel disease

Objective: Our aim was to study the frequency, severity, and outcome of pat ients with Crohn's disease and ulcerative colitis treated with 6-mercaptopu rine (6MP) who developed shingles during treatment, and to recommend manage ment. While varicella can be severe in young people immunocompromised by st eroids, the incidence of herpes tester in older people with inflammatory bo wel disease (IBD) and whether its severity is influenced by 6MP and azathio prine are unknown. Methods: Data were collected from our IBD Center on 550 patients with IBD to identify those who developed shingles while on 6MP, it s severity, the dose and duration of 6MP, and the management of the 6MP, Re sults: Twelve of 550 patients with IBD treated with 6MP developed shingles. In two with herpes tester ophthalmicus the pain was prolonged, and one pat ient developed encephalitis which was brief and uncomplicated; in nine pati ents the course was benign. Acyclovir should be the treatment of choice eve n though it was available in only three cases. Conclusions: Shingles occurs more often in IBD patients treated with 6MP than in those who are not, but the course is usually benign and there has been no mortality. The 6MP shou ld be stopped temporarily until severity is established but if the underlyi ng disease warrants further treatment the 6MP should be restarted. (Am J Ga stroenterol 1999;94:424-426, (C) 1999 by Am. Cell. of Gastroenterology).