MMF-related Colitis Carrying GVHD-like Pathologic Feature in Renal Transplant Recipient.
- Author:
Jinmo KANG
1
;
Jongwon HA
;
Ikjin YUN
;
Taeseung LEE
;
Junghoon LEE
;
Wooho KIM
;
Sang Joon KIM
Author Information
1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. sjkimgs@plaza.snu.ac.kr
- Publication Type:Case Report
- Keywords:
Mycophenolate Mofetil (MMF);
Diarrhea;
GVHD- like colitis;
Single cell apoptosis
- MeSH:
Abscess;
Adult;
Apoptosis;
Atrophy;
Azathioprine;
Bile Ducts;
Biopsy;
Blood Cell Count;
Bone Marrow;
Colitis*;
Cyclosporine;
Cystitis;
Cytomegalovirus;
Diarrhea;
Goblet Cells;
Graft vs Host Disease;
Humans;
Immunocompromised Host;
Immunosuppressive Agents;
Kidney Transplantation;
Liver;
Liver Function Tests;
Mothers;
Organ Transplantation;
Pancreas;
Prednisolone;
Reference Values;
Serologic Tests;
Skin;
Transplantation*;
Transplants;
Weight Loss
- From:The Journal of the Korean Society for Transplantation
2004;18(2):194-197
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Graft-Versus-Host Disease (GVHD) is known to be associated with bone marrow transplantion. It is very rare in solid organ transplantation, especially in renal transplantation. There were only a few reported cases of GVHD in pancreas, liver transplant recipients or transfusion associated GVHD in immunocompromised patients. CASE: A 36 years-old man received renal transplantation from his mother on May 20th, 1996. Cyclosporine A, azathioprine & prednisolone were used as immunosuppressants. There was no episode of acute rejection after transplantation. After transplantation, he suffered from cytomegalovirus (CMV) cystitis, bile duct stones. He had never been transfused blood products since transplantation. Thereafter, his post-transplantation course was quite favorable until December 20th, 2003, when troublesome diarrhea and weight loss developed. At that time, he was taking 1.25 g/day of MMF (25 mg/kg/day). Hospital course: The MMF dose was reduced to 500mg bid (312 mg/m2/dose or 20 mg/kg/day) under the suspicion of CMV colitis. The results of serologic test and culture for CMV were all negative. The colonoscopic biopsy revealed pathologic features such as crypt drop-out, crypt abscess, crypt atrophy, single cell apoptosis and goblet cell depletion just like in GVHD. He had no necrotic skin lesion and his liver function test was in normal range. However, his complete blood count showed pancytopenic features. The MMF was discontinued immediately after the pathologic results were reported. His diarrhea and other clinical sym-ptoms were disappeared, and the pancytopenic features recovered gradually after discontinuation of MMF. He also gained 2.6 kg weight and discharged with good graft function.
