Mycophenolate mofetil-related colitis in a paediatric patient after kidney transplant

Mycophenolate mofetil (MMF) is an immunosuppressive agent, the gastrointestinal side effects of which include abdominal pain, diarrhoea, and vomiting. MMF may also cause symptomatic colitis, although it is a rare condition. We present herein the case of a boy with chronic kidney disease, lasting since the neonatal period, and caused by WT1 gene mutation. The patient developed colitis during an immunosuppressive therapy applied after a kidney transplant. Histopathology of intestinal biopsy specimens revealed features of MMF-related colitis. A modification of the immunosuppressive treatment and the implementation of a nutritional programme to the patient resulted in the disappearance of clinical signs and helped in a gradual body weight gain.

REFERENCES (14)

Querfeld U, Weber LT. Mycophenolate mofetil for sustained remission in nephrotic syndrome. Pediatr Nephrol 2018; 33: 2253-2265.

Google Scholar

Geboes K, Van Eyken P. Inflammatory bowel disease unclassified and indeterminate colitis: the role of the pathologist. J Clin Pathol 2009; 62: 201-205.

Google Scholar

Phatak UP, Seo-Mayer P, Jain D, et al. Mycophenolate mofetil- induced colitis in children. J Clin Gastroenterol 2009; 43: 967-969.

Google Scholar

Patil DT, Odze RD. Biopsy diagnosis of colitis: an algorithmic approach. Virchows Arch 2018; 472: 67-80.

Google Scholar

Durlik M, Przybyłowski P. Zalecenia dotyczące leczenia immunosupresyjnego po przeszczepieniu narządów unaczynionych. Fundacja Zjednoczeni dla Transplantacji, Warszawa 2018.

Google Scholar

Zagożdżon I, Żurowska A. Otarbiające stwardnienie otrzewnej u dzieci dializowanych otrzewnowo. Forum Nefrol 2020; 13: 22-29.

Google Scholar

Berger I, Haubrich K, Ensom MHH, et al. Relationship of limited sampling strategy and adverse effects of mycophenolate mofetil in pediatric renal transplant patients. Pediatr Transplant 2019; 23: e13355.

Google Scholar

Farooq PD, Urrunaga NH, Tang DM, et al. Pseudomembranous colitis. Dis Mon 2015; 61: 181-206.

Google Scholar

Villanacci V, Reggiani-Bonetti L, Leoncini G, et al. Histopathology of non-IBD colitis. A practical approach from the Italian Group for the study of the gastrointestinal tract (GIPAD). Pathologica 2021; 113: 54-65.

Google Scholar

10.

Riddle DJ, Dubberke ER. Clostridium difficile infection in solid organ transplant recipients. Curr Opin Organ Transplant 2008; 13: 592-600.

Google Scholar

11.

Kujawa-Szewieczek A, Adamczak M, Kwiecień K, et al. Analysis of Clostridium difficile infections in patients hospitalized at the neurological ward in Poland. Postepy Hig Med Dosw 2016; 70: 505-513.

Google Scholar

12.

Calmet FH, Yarur AJ, Pugazhendhi G, et al. Endoscopic and histological features of mycophenolate mofetil colitis in patients after solid organ transplantation. Ann of Gastroenterol 2015; 28: 366-373.

Google Scholar

13.

Selbst MK, Ahrens WA, Robert ME, et al. Spectrum of histologic changes in colonic biopsies in patients treated with mycophenolate mofetil. Mod Pathol 2009; 22: 737-743.

Google Scholar

14.

Kim K, Gardner JM, Schwartz M, et al. Mycophenolate mofetil- related colitis. A case report. Korean J Pathol 2010; 44: 333-337.

Google Scholar

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