Squamous cell carcinoma in a patient with inflammatory bowel disease: A case report of complications with long-term Azathioprine use

Inflammatory Bowel Disease (IBD) is associated with an increased risk of malignancies, particularly in patients receiving long-term immunosuppressive therapy. This case report presents a 79-year-old male with a long-standing history of IBD who developed squamous cell carcinoma (SCC) following prolonged use of Azathioprine. A 79-year-old male with a 20-year history of IBD presented to Shahid Rajaei Hospital in Tonekabon, complaining of abdominal pain and hematochezia. He had been on Azathioprine since the diagnosis of IBD. Five years prior, he developed scalp lesions, which was biopsied and confirmed as SCC. Despite undergoing three surgical interventions to excise the lesions and receiving adjuvant chemotherapy and radiotherapy, the patient exhibited persistent disease without improvement. Recent clinical evaluations revealed recurrent infection and purulent discharge at the surgical site, raising concerns regarding the underlying malignancy. The patient’s history indicates that the development of SCC may be attributed to the long-term immunosuppressive effects of Azathioprine, which can predispose individuals to skin cancers. This case underscores the importance of vigilant monitoring for malignancies in patients on long-term immunosuppressive therapy, particularly those with pre-existing conditions like IBD. This case highlights the potential complications of long-term Azathioprine use in IBD patients, including the risk of developing SCC. Clinicians should consider alternative management strategies and regular surveillance for skin lesions in similar patient populations to mitigate the risks associated with immunosuppressive therapies. • Long-standing UC increases cancer risk: Patients with UC, especially those on long-term immunosuppression, have heightened vulnerability to developing malignancies, including skin cancers. • Azathioprine and skin cancers: Azathioprine, a common UC treatment, is linked to increased non-melanoma skin cancer risk, particularly with prolonged use. This emphasizes the importance of regular dermatological monitoring in these patients. • Immunosuppression complicates cancer management: Managing skin cancers in patients with UC is challenging due to their underlying immunosuppression, potentially leading to persistent lesions and recurrent infections. • Immunotherapy offers potential: Immunotherapy, like pembrolizumab, shows promise for treating advanced skin cancers in UC patients, but its efficacy can vary. • Multidisciplinary approach essential: Optimizing patient outcomes requires a coordinated multidisciplinary approach involving gastroenterologists, dermatologists, and oncologists to address the complexities of managing both UC and related malignancies.