Mycophenolate Mofetil-Related Colitis - A Case Report -

Mycophenolate Mofetil-Induced Colonic Injury Manifesting Endoscopically As Ischemic Colitis

Mycophenolate mofetil (MMOF) is a commonly used immunosuppressive prodrug in kidney transplant patients. However, it is not without side effects. The most common of these is diarrhea which inadvertently leads to colonoscopic and endoscopic evaluation when all other workup returns negative. Colonoscopies often show diffuse ulcers and colitis changes depending on the degree of diarrhea. In rare situations, MMOF-induced ischemic colitis may occur on gross endoscopy. We describe an unusual phenomenon of an adult male status post renal transplant with histopathologically diagnosed MMOF-induced colitis who developed gross endoscopic findings concerning ischemic colitis. Our case highlights the importance of recognizing that MMOF-induced colonic changes can rarely mimic ischemic colitis. With this in mind, we aim for gastroenterologists to better understand the varying endoscopic colonic findings of this immunosuppressive drug.

Colitis eosinofílica inducida por micofenolato: reporte de caso

El micofenolato de mofetil es un medicamento usado para la prevención del rechazo de aloinjertos en pacientes con trasplante de órganos. La colitis eosinofílica por micofenolato es una condición reconocida en pacientes con antecedente de trasplante renal y diarrea persistente, en la cual es necesaria la toma de biopsia para lograr un diagnóstico y tratamiento apropiados. Se presenta el caso de un niño de 11 años con diarrea; se realizó biopsia de colon que mostró edema e infiltrado inflamatorio eosinofílico en lámina propia con formación de microabscesos, con daño epitelial y de las criptas. Dada la ausencia de otra causa del cuadro clínico, se retiró el micofenolato del esquema de tratamiento, con resolución de la sintomatología. La escala de naranjo para causalidad de reacción adversa a medicamentos fue definitiva con un puntaje de 10. Se aporta a la literatura con la caracterización de los hallazgos histopatológicos en la lesión del colon inducida por micofenolato.

A case series of de novo inflammatory bowel disease after kidney transplantation

Diarrhea, which is common after transplantation, may be due to infections and immunosuppressive therapy. Inflammatory bowel disease (IBD) de novo or as an exacerbation of pre-existent disease is a rare complication after kidney transplantation with pre-existing disease having a less aggressive clinical course than the de novo disease. Cytomegalovirus mismatch, prescription of tacrolimus instead of cyclosporine or mycophenolate mofetil rather than azathioprine as well as low-dose corticosteroid treatments have been linked to an increased incidence of IBD. This series of renal transplant recipients with de novo IBD showed a higher incidence and more aggressive course than that previously described, possibly related to increased use of tacrolimus with minimization of steroids.