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With great interest we read the article by Kaskas et al (Gut 2003;52:140–2) about safe treatment of thiopurine S-methyltransferase (TPMT) deficient Crohn’s disease patients with azathioprine (AZA). In this paper it is illustrated that TPMT-deficient patients can be successfully treated with very low doses of AZA (∼10% of standard initial dose).
Unfortunately, this is not the case for all homozygous mutant TPMT allele carriers. This is demonstrated by the case report of an exceptional thiopurine S-methyltransferase deficient patient with inflammatory bowel disease who we identified recently. A 19-year-old man with ulcerative colitis who was attending the outpatient clinic was treated with …