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Azathioprine hypersensitivity in a patient affected by systemic lupus erythematosus

on the basis of the following features: butterfly rash, discoid lesions on the arms and on the ears, polyarthritis, leukopenia, antinuclear and anti-dsDNA antibody presence ( 1:2560 with homogenous pattern and 1:20 respectively). Therapy with prednisone 12.5 mg/day and hydroxychloroquine 200 mg/day was started with little significant amelioration of the clinical picture and the laboratory findings. Six months later the polyarthritis still persisted, antinuclear and anti-dsDNA antibodies could still be detected, ESR was 35 mm/h, white blood cell count was 3200 celIS/MM3 without eosinophilia, while CRP was normal.