Concomitant Alopecia Areata and Profound Bone Marrow Suppression: An Unusual Manifestation of Azathioprine Toxicity

This case report details a rare occurrence of azathioprine-induced alopecia areata (AA) and severe bone marrow suppression in a 42-year-old man undergoing treatment for chronic urticaria. Azathioprine, an immunosuppressive drug, is typically associated with myelosuppression, but the sudden onset of AA is unusual. After 1 month of therapy, the patient experienced patchy hair loss and severe myelosuppression. Histopathology confirmed AA with lymphocytic infiltration around hair follicles. Discontinuation of azathioprine led to improved hematological parameters and hair regrowth, indicating a potential link between the drug and these adverse effects. This case underscores the need for careful monitoring of azathioprine's side effects due to the unpredictable nature of immunomodulatory therapy.