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Alakkas Z, Gari AM, Makhdoum S, AlSindi EA. Mycophenolate-induced colitis in a patient with lupus nephritis: a case report and review of the literature. J Med Case Rep 2024; 18:229. [PMID: 38689344 PMCID: PMC11061913 DOI: 10.1186/s13256-024-04539-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Mycophenolate mofetil (MMF) is an immunosuppressive drug that is frequently prescribed to patients with rheumatological diseases. MMF's side effects include abdominal discomfort, nausea, vomiting, and other gastro-intestinal side effects, which typically appear in the first few months of treatment. However, late-onset diarrhea does not rule out the presence of MMF-induced colitis, which can be misdiagnosed since it is linked to a broad range of histopathological characteristics, including alterations that resemble inflammatory bowel disease, graft-versus-host disease, and ischemia. The differences in treatment response may be explained by the complexity of the histopathologic characteristics. CASE PRESENTATION Here we present a case of a 29-year-old Arabian female with lupus nephritis who started on MMF as induction therapy. In two months, the patient was presented to the Emergency Department with diarrhea and manifestations of severe dehydration. Infectious diseases and adverse drug events were suspected, so the patient was admitted for further workup, and MMF was stopped. The patient was diagnosed with MMF-induced colitis based on colonoscopy and histological findings. Fourteen days after stopping MMF, she was within her baseline. CONCLUSION The purpose of this paper is to report a case of early-onset MMF-induced colitis in a patient with lupus nephritis who had started MMF as induction therapy. A review of the available literature on this uncommon immunosuppressive effect is also presented.
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Affiliation(s)
- Ziyad Alakkas
- Rheumatology Unit, Internal Medicine Department, King Abdul-Aziz Specialist Hospital, Taif, Saudi Arabia.
| | - Abdulaziz M Gari
- Rheumatology Unit, Internal Medicine Department, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Sara Makhdoum
- Histopathology Department, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Eman A AlSindi
- Rheumatology Unit, Internal Medicine Department, King Fahad Hospital, Jeddah, Saudi Arabia
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Jang MK, Markowitz TE, Andargie TE, Apalara Z, Kuhn S, Agbor-Enoh S. Cell-free chromatin immunoprecipitation to detect molecular pathways in heart transplantation. Life Sci Alliance 2023; 6:e202302003. [PMID: 37730434 PMCID: PMC10511822 DOI: 10.26508/lsa.202302003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/22/2023] Open
Abstract
Existing monitoring approaches in heart transplantation lack the sensitivity to provide deep molecular assessments to guide management, or require endomyocardial biopsy, an invasive and blind procedure that lacks the precision to reliably obtain biopsy samples from diseased sites. This study examined plasma cell-free DNA chromatin immunoprecipitation sequencing (cfChIP-seq) as a noninvasive proxy to define molecular gene sets and sources of tissue injury in heart transplant patients. In healthy controls and in heart transplant patients, cfChIP-seq reliably detected housekeeping genes. cfChIP-seq identified differential gene signals of relevant immune and nonimmune molecular pathways that were predominantly down-regulated in immunosuppressed heart transplant patients compared with healthy controls. cfChIP-seq also identified cell-free DNA tissue sources. Compared with healthy controls, heart transplant patients demonstrated greater cell-free DNA from tissue types associated with heart transplant complications, including the heart, hematopoietic cells, lungs, liver, and vascular endothelium. cfChIP-seq may therefore be a reliable approach to profile dynamic assessments of molecular pathways and sources of tissue injury in heart transplant patients.
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Affiliation(s)
- Moon Kyoo Jang
- https://ror.org/01cwqze88 Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD, USA
| | - Tovah E Markowitz
- https://ror.org/01cwqze88 NIAID Collaborative Bioinformatics Resource, Integrated Data Sciences Section, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Temesgen E Andargie
- https://ror.org/01cwqze88 Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD, USA
- Department of Biology, Howard University, Washington, DC, USA
| | - Zainab Apalara
- https://ror.org/01cwqze88 Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD, USA
| | - Skyler Kuhn
- https://ror.org/01cwqze88 NIAID Collaborative Bioinformatics Resource, Integrated Data Sciences Section, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Sean Agbor-Enoh
- https://ror.org/01cwqze88 Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD, USA
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Jang MK, Markowitz TE, Andargie TE, Apalara Z, Kuhn S, Agbor-Enoh S. Cell-free Chromatin Immunoprecipitation to detect molecular pathways in Physiological and Disease States. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.24.525414. [PMID: 36789421 PMCID: PMC9928031 DOI: 10.1101/2023.01.24.525414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Patient monitoring is a cornerstone in clinical practice to define disease phenotypes and guide clinical management. Unfortunately, this is often reliant on invasive and/or less sensitive methods that do not provide deep phenotype assessments of disease state to guide treatment. This paper examined plasma cell-free DNA chromatin immunoprecipitation sequencing (cfChIP-seq) to define molecular gene sets in physiological and heart transplant patients taking immunosuppression medications. We show cfChIP-seq reliably detect gene signals that correlate with gene expression. In healthy controls and in heart transplant patients, cfChIP-seq reliably detected housekeeping genes. cfChIP-seq identified differential gene signals of the relevant immune and non-immune molecular pathways that were predominantly downregulated in immunosuppressed heart transplant patients compared to healthy controls. cfChIP-seq also identified tissue sources of cfDNA, detecting greater cell-free DNA from cardiac, hematopoietic, and other non-hematopoietic tissues such as the pulmonary, digestive, and neurological tissues in transplant patients than healthy controls. cfChIP-seq gene signals were reproducible between patient populations and blood collection methods. cfChIP-seq may therefore be a reliable approach to provide dynamic assessments of molecular pathways and tissue injury associated to disease.
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Affiliation(s)
- Moon K. Jang
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision. Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD
| | - Tovah E. Markowitz
- NIAID Collaborative Bioinformatics Resource, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD
| | - Temesgen E. Andargie
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision. Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD
| | - Zainab Apalara
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision. Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD
| | - Skyler Kuhn
- NIAID Collaborative Bioinformatics Resource, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD
| | - Sean Agbor-Enoh
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision. Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
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Morris CC, Stroud SC, Golconda U, Gregoire SA, Juneman EB. Orthotopic Heart Transplant Recipient with Enteric-coated Mycophenolate Sodium (Myfortic) Induced Colitis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920235. [PMID: 32404861 PMCID: PMC7252833 DOI: 10.12659/ajcr.920235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Male, 66-year-old Final Diagnosis: Drug-induced colitis Symptoms: Abdominal discomfort • anorexia • diarrhea • weight loss Medication: Enteric-coated mycophenolate sodium (Myfortic) Clinical Procedure: Colonoscopy • colon biopsy Specialty: Cardiology • Infectious Disease
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Affiliation(s)
- Craig C Morris
- Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Steven C Stroud
- Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Sharon A Gregoire
- Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Elizabeth B Juneman
- Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA
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Farooqi R, Kamal A, Burke C. Mycophenolate-induced Colitis: A Case Report with Focused Review of Literature. Cureus 2020; 12:e6774. [PMID: 32117661 PMCID: PMC7041651 DOI: 10.7759/cureus.6774] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Mycophenolate mofetil (MMF) is an immunosuppressive medication used for the management of various autoimmune diseases, and patients with bone marrow and solid organ transplants. Gastrointestinal side effects are seen 45% of the time and they include nausea (29%), vomiting (23%), constipation (38%), diarrhea (50%-92%), and colitis (9%). In 98% of cases, resolution of diarrhea occurs within 20 days upon discontinuation of the MMF. Data is scarce regarding approach in the treatment of MMF-induced colitis. We report a case of MMF-induced colitis diagnosed by colonoscopy and histopathology. This case illustrates the challenges encountered while managing MMF-induced colitis.
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Affiliation(s)
- Rehan Farooqi
- Internal Medicine, Medstar Union Memorial Hospital, Baltimore, USA
| | - Afrin Kamal
- Gastroenterology, Cleveland Clinic, Cleveland, USA
| | - Carol Burke
- Gastroenterology, Cleveland Clinic, Cleveland, USA
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