Mycophenolate Mofetil – Associated Pseudo-Crohn Colitis

Abstract

Mycophenolate mofetil (MMF) was introduced in the pratice of clinical transplantation for more than 10 years. In live transplant patients, its use evolved from toxicity-sparing protocols to the most common regimen of maintenance immunosupression at hospital discharge. Gastrointestinal toxicity however, usually manifested as chronic diarrhea of unknown origin, is a common side effect, but only recently a pattern of injury described as Crohn's like changes has been defined. A male Caucasian 20 years old patient had OLT 6 years ago for isoflurane fulminant liver failure. For five year, on a double maintenance regimen of tracholymus and MMF, he was clinically stable through with insulin dependent diabetes mellitus from the 8th month post OLT. On his 5 year postop, he began to experience chronic diarrhea, progressively prolonged, with blood and night fever. We found mycrocytic anemia, ESR of 100 and hipokaliemia. He was admitted for 3 times, when several microbiologic, histologic and endoscopic studies were performed. After finding a Cohn's like pancolitis with patchy erithema, granularity and longitudinal serpiginous ulcers (with ileal and rectal sparring), several attempts were made to find CMV, tuberculosis or other mycobacteria, without success. Immunosupression was reduced and developed steroid sensitive rejection. After MMF withdrawal and rejection control, there was a clinical and endoscopic significative improvement. We present the endoscopic and histologic iconography, supporting the diagnosis of MMF Pseudo-Crohn's Colitis.