Azathioprine has been extensively used in the management of
inflammatory bowel diseases. It might cause pancreatic damage in the form of either asymptomatic elevation in serum
amylase/
lipase or overt
acute pancreatitis. Here we report the case of a 61-year-old patient with
ulcerative colitis who had been treated with
azathioprine for three years, achieving clinical remission. During treatment he presented an asymptomatic elevation of serum pancreatic
enzymes, without any signs of
pancreatitis at imaging. This evidence brought us to reassess the
drug dosage, without achieving a normalization of biochemical analysis.
Autoimmune pancreatitis was excluded. One year after the
suspension of
azathioprine, we still face persistent high levels of
amylase/
lipase. Normalization of enzymatic values in patients who develop intolerance to
azathioprine, in the form of either asymptomatic elevation in serum
amylase/
lipase or overt
acute pancreatitis, is usually achieved in about two months after stopping
drug intake. Asymptomatic elevation in serum pancreatic
enzymes in the absence of
pancreatic disease is reported in the literature and defined as "Gullo's syndrome," but nobody of the subjects studied had been treated in the past with pancreatotoxic drugs. Might this case be defined as "benign pancreatic hyperenzymemia"?