# Hepatic Peliosis due to Azathioprine in a Pediatric Kidney Transplant Recipient

## TL;DR

A 5-year-old girl developed liver damage from azathioprine, an immunosuppressant used after a kidney transplant.

## Contribution

This case highlights azathioprine's rare but serious side effect of hepatic peliosis in pediatric transplant patients.

## Key findings

- Hepatic peliosis occurred in a child 9 months after kidney transplant while on azathioprine.
- Azathioprine is a known immunosuppressant but its rare liver toxicity is under-recognized in pediatric cases.

## Abstract

Azathioprine, an antimetabolite drug interfering with purines synthesis, is one of the immunosuppressive maintenance therapy used in solid organ transplant or dysimmune disease. We report the case of a 5-year-old-girl with Stage 5 chronic kidney disease, who developed hepatic peliosis due to azathioprine used 9 months after kidney transplant.