Side effects due to azathioprine (the nitroimidazole derivative of 6-mercaptopurine) can be classified as toxic (myelosuppression, hepatotoxicity) and idiosyncratic (fever, rigors, arthralgias, pneumonitis, and gastrointestinal symptoms). Although the toxic effects are due to 6-mercaptopurine, the hypersensitivity reactions are believed to be caused by the nitroimidazole moiety.

Azathioprine toxicity can occur during long-term treatment of myasthenia gravis. y , y Among 104 treated patients with myasthenia gravis, side effects occurred in 35 percent and included, in decreasing frequency, hematological, 18 percent; gastrointestinal, 13 percent; infectious, 13 percent; and elevation of liver enzymes 6 percent. The medicine was discontinued temporarily in 11 percent of the patients. In five patients, a malignant tumor was diagnosed, but a causal relationship seemed likely in only one. y Neurological toxicity is rare with azathioprine. Two patients with recurrent meningitic reactions following azathioprine ingestion have been presented in the literature; they were being treated for lupus of the CNS. y

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