De Novo Ulcerative Colitis and Autoimmune Hepatitis After Living Related Liver Transplantation From Cytomegalovirus-Positive Donor to Cytomegalovirus-Negative Recipient: A Case Report

Abstract

BackgroundDe novo autoimmune hepatitis (AIH) after liver transplantation (OLT) has been reported; however, de novo ulcerative colitis (UC) combined with AIH after OLT is rare. Materials and methodsWe report a patient who suffered de novo UC with AIH after living related OLT (LRLT) due to fulminant hepatitis using a cytomegalovirus (CMV)-positive donor to a CMV-negative recipient. ResultsA 32-year-old man underwent LRLT due to fuluminant hepatis 4 years prior. He was admitted for colitis with diarrhea, abdominal pain, and high fever in March 2010. The abdominal computed tomography revealed severe jejunal edema. Anti-infectious therapies for bacterial, fungal, and CMV cases were ineffective. Small bowel endoscopy demonstrated erosion, redness, ulceration, and edema from the stomach to the jejunum. However, the origin of the colitis was not clear. Thereafter he displayed melena with a high fever and abdominal pain. The colon revealed diffuse inflammation with pseudopolyposis. De novo UC or CMV infection was suspected. His symptoms improved upon administration of Salazopyrin and denosine. Moreover, he suffered de novo AIH, which was diagnosed by liver biopsy 3 months after the de novo UC. Steroid therapy improved the AIH. ConclusionsIt has been reported that CMV is involved with UC and rejection. Our case suggested that CMV might induce de novo UC or AIH in CMV-negative recipients.