A patient with Crohn's disease is prescribed azathioprine. Which finding would concern the nurse that the patient is experiencing a serious side effect of the medication?

A. A new reported temperature of 99.2 degrees Fahrenheit: A low-grade temperature of 99.2°F is not typically concerning for a patient on azathioprine, as mild fluctuations can occur. However, significantly elevated fevers would raise concern for infection due to immunosuppression, which is a known risk with this medication. B. The patient reports 3 episodes of diarrhea over the last week: Intermittent diarrhea can be expected in patients with Crohn’s disease due to underlying intestinal inflammation. This finding alone does not necessarily indicate a medication-related adverse effect unless it is severe, persistent, or associated with other concerning symptoms. C. Dry cough when waking up in the morning: A mild dry cough may be related to environmental factors or minor irritation and is not a classic or serious adverse effect of azathioprine. Persistent or worsening respiratory symptoms would require further evaluation but are not the most immediate concern here. D. Alanine aminotransferase (ALT) 65 units (reference range: 5–35 units): Elevated ALT indicates hepatocellular injury, which is a known serious adverse effect of azathioprine. This immunosuppressant can cause hepatotoxicity, and rising liver enzymes require prompt evaluation and possible adjustment or discontinuation of therapy to prevent further liver damage.