Author ORCID Identifier


Corresponding Author

Dr. Mahabaleshwar Mamadapur,

Assistant Professor, Department of Clinical Immunology and Rheumatology JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore

email: mahabaleshwarm@jssuni.edu.in


Azathioprine is a pro-drug and is metabolized by the TPMT enzyme in the body. In South Asians, Azathioprine is known to cause alopecia and bone marrow suppression in patients with TPMT enzyme deficiency. In India, the prevalence of TPMT mutation varies from 1.2- 10%. A new mutation was detected in 2014, NUDT15 whose incidence varies from 8.5-16%. Patients with mutation in both TPMT and NUDT15 develop myelosuppression faster. In our case, alopecia manifested as the first clinical feature of Azathioprine myelosuppression. Physicians need to recognize early clinical clues (alopecia) to avoid the impending development of myelosuppression and to look for possible gene mutations.

Publication Date



JSS Academy of Higher Education and Research

Conflict of Interest



Azathioprine, Alopecia, Myelosuppression, NUDT15, TPMT

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