Azathioprine-Induced Pancreatitis in a Patient With Autoimmune Hepatitis: A Case Report.

A 67-year-old woman with biopsy-proven autoimmune hepatitis (AIH) developed acute pancreatitis shortly after starting azathioprine (AZA) and budesonide. She presented with abdominal pain, fever, and elevated lipase levels. Imaging confirmed acute interstitial edematous pancreatitis, and common etiologies-including gallstones, alcohol use, and hypertriglyceridemia-were ruled out. AZA was identified as the likely cause and was discontinued, resulting in full clinical recovery with supportive care. The patient was subsequently transitioned to mycophenolate mofetil (MMF) for continued immunosuppression. This case highlights the importance of early recognition of azathioprine-induced pancreatitis (AIP), particularly within the first few weeks of therapy. It also demonstrates the utility of MMF as a viable second-line agent in AZA-intolerant patients with AIH.