J Korean Soc Transplant.  2004 Dec;18(2):194-197.

MMF-related Colitis Carrying GVHD-like Pathologic Feature in Renal Transplant Recipient

• Kang J
• Ha J
• Yun I
• Lee T
• Lee J
• Kim W
• Kim SJ

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.

Keyword

Mycophenolate Mofetil (MMF); Diarrhea; GVHD- like colitis; Single cell apoptosis

MeSH Terms

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
Azathioprine
Cyclosporine
Immunosuppressive Agents
Prednisolone