Is it safe to continue azathioprine in a patient with severe bilateral panuveitis (thought to be related to sarcoidosis) and benign ethnic neutropenia, given worsening neutropenia since starting the medication, or should an alternative immunosuppressive agent be considered?

In this case, I would consider stopping azathioprine and switching to an alternative medication, such as an anti-TNF agent. Although not a large drop in the PMN, azathioprine is known to cause leukopenia, and in a patient with known neutropenia, extra precaution should be taken. In the case of uveit...

I think I would lean towards less neutropenic agents: DMARD MTX vs escalation to TNF. I could consider MMF or MFA but more leuko/neutropenia there. Even JAK would be safer if an appropriate CV candidate.

In a patient with presumed (as stated in the history provided; unclear how long the patient has been neutropenic) benign ethnic neutropenia who developed increasing neutropenia while on azathioprine for the treatment of bilateral panuveitis thought to be related to sarcoidosis, I would certainly con...