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Azathioprine Pancreatitis — RACP Paediatrics MCQ

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HardGastroenterologyAzathioprine PancreatitisRACP Paediatrics

A 14-year-old with Crohn disease develops characteristic acute pancreatitis three weeks after starting azathioprine. Ultrasound shows no gallstones, triglycerides and calcium are normal, and no infection is identified. What should happen to azathioprine?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Stop azathioprine and avoid rechallenge because thiopurine pancreatitis is idiosyncratic

Explanation lettering: E = shown as A · D = shown as B · B = shown as C · A = shown as D · C = shown as E

D is correct because the timing and exclusion of common alternatives support thiopurine-induced pancreatitis, for which the implicated thiopurine is stopped and rechallenge avoided. E risks recurrence. A incorrectly assumes dose dependence. B may reproduce a class-related hypersensitivity reaction and requires specialist alternative selection. C uses symptom resolution rather than causality and safety. Crohn disease control should be replanned with gastroenterology.

Reference: Therapeutic Goods Administration, product-information safety updates May 2026: https://www.tga.gov.au/news/safety-updates/product-information-safety-updates-may-2026