Azathioprine (AZA) is a widely prescribed immunosuppressive agent in the long-term management of autoimmune hepatitis (AIH), valued for its steroid-sparing properties and efficacy in maintaining disease remission. While its common adverse effects – such as myelosuppression, hepatotoxicity, and gastrointestinal intolerance – are well-recognized and routinely monitored, hypersensitivity pneumonitis (HP) remains an exceptionally rare but potentially life-threatening complication. Herein, we describe a 21-year-old female patient with AIH diagnosed at age 18. Who developed possible AZA-induced HP during the 3rd year of continuous therapy. We discuss the potential immunopathogenic mechanisms, review the limited literature on AZA-related pulmonary toxicity, and emphasize the importance of early recognition to prevent irreversible lung injury and optimize patient outcomes.

Introduction: Mesalazine is a cornerstone therapy for ulcerative colitis (UC). Although generally safe, it can cause rare but life-threatening cardiopulmonary complications such as pleuropericarditis. Case description: We report on a patient with a UC flare who presented with dyspnoea, where concurrent pericardial and pleural effusions were detected. The inflammatory response was likely suppressed by concomitant corticosteroid therapy, which masked the clinical manifestations of mesalazine-induced serositis and delayed diagnosis. Two years later, the patient re-presented with recurrent massive pericardial effusion causing tamponade physiology and pleural effusion. Pericardial fluid analysis revealed a haemorrhagic, neutrophil-dominant profile (95% polymorphonuclear leukocyte, mimicking bacterial infection rather than the typically described eosinophilic pattern. Extensive cultures were negative. Following the discontinuation of mesalazine, rapid clinical and radiologic improvement was observed, confirming drug-induced pleuropericarditis. Discussion: This case highlights that mesalazine-associated pleuropericarditis can be obscured by corticosteroids, leading to diagnostic delays. Furthermore, sterile inflammatory reactions to mesalazine can present with atypical neutrophilic features resembling bacterial infection, necessitating a high index of suspicion in inflammatory bowel disease patients presenting with serositis.

Background/Objectives: Acute gastroesophageal variceal bleeding (AGEVB) is a major cause of mortality and treatment failure in cirrhotic patients. Early risk stratification remains essential for optimizing management and intensive monitoring. To compare the prognostic performance of Child–Pugh (CTP), Model for End-Stage Liver Disease–Na (MELD-Na), platelet count-to-spleen diameter ratio (PC/SD), and neutrophil-to-lymphocyte ratio (NLR) in predicting 6-week mortality and early rebleeding after AGEVB. Methods: This retrospective single-center cohort study included 150 cirrhotic patients admitted with acute GEVB. Baseline laboratory and clinical parameters were used to calculate CTP, MELD-Na, PC/SD, and NLR. Predictive accuracy for mortality and rebleeding was evaluated using receiver operating characteristic analysis and penalized multivariable logistic regression. Results: Six-week mortality occurred in 11.3% and early rebleeding in 20.0% of patients. CTP and MELD-Na scores were significantly higher among non-survivors and patients with rebleeding. The CTP score demonstrated the highest discriminative performance for both outcomes. NLR and PC/SD showed limited predictive value and were not independent predictors after adjustment. Conclusions: Scores reflecting hepatic functional reserve, particularly the Child–Pugh score, provide superior prognostic accuracy compared with inflammatory and portal hypertension markers in AGEVB.