Fast atrial fibrillation induced by treatment of psoriasis with azathioprine.

3 Rivlin RS, Young EA, eds. Symposium on evidence relating selected vitamins and minerals to health and disease in the elderly population in the United States.competence of the elderly. Effect of short term nutritional supplementation on cell-mediated immunity and lymphocyte subsets. Fast atrial fibrillation induced by treatment of psoriasis with azathioprine We describe a patient with psoriasis who developed fast atrial fibrillation in an idiosyncratic reaction to azathioprine. Case report A 60 year old man was referred for treatment of widespread psoriasis. He had suffered from the condition for over 20 years and had received various topical treatments and photochemotherapy. The response to psoralens and ultraviolet A treatment had been unsatisfactory after some initial improvement, and immediately before his referral to our department he had been using potent topical steroid ointments. He had a history of heavy alcohol consumption. Examination showed widespread confluent plaques of psoriasis, which had a glazed, thinned appearance. No abnormal cardio-vascular signs were found, and he was in sinus rhythm at 60 beats/min with a blood pressure of 140/90 mm Hg. An electrocardiogram on admission (figure (A)) and chest x ray film were normal. We considered him to be unsuitable for routine treatment with dithranol, and azathioprine 50 mg three times daily was started. He received no other drug. Four days later he became febrile, and over the next 48 hours his temperature reached 40°C and was accompanied by a sinus tachycardia. Azathioprine was stopped, and repeated cultures of blood and urine yielded negative results. Three days later, after the fever and tachycardia had completely settled, azathioprine was reintroduced. Within five hours he developed rigors and a fever (39°C) and was found to be in fast atrial fibrillation (figure (B)). Azathioprine was again immediately stopped, and the atrial fibrillation resolved within hours on bed rest. Tests of thyroid function yielded normal results, and serum electrolyte concentrations and a later electrocardiogram (figure (C)) were normal. Subsequent inquiries about previous treatment at another hospital showed that he had developed a fever while taking azathioprine seven years before. It had recurred on reintroduction of the drug. A B C Electrocardiogram (lead II) (A) on admission; (B) five hours after azathio-prine 50 mg; and (C) after bed rest and withdrawal of azathioprine. Commxent Azathioprine is a widely used immunosuppressive agent that is effective in severe and disabling psoriasis.1 Toxic effects include depression of bone marrow, hepatotoxicity, gastrointestinal upsets, reduced resistance …