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Mycophenolate mofetil-induced segmental colitis mimicking ischemic colitis.

Kevin Johal1, Shiva K Ratuapli2, Dora M Lam-Himlin3

  • 1Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.

Case Reports in Gastroenterology
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Mycophenolate mofetil (MMF) can cause segmental colitis, a rare form of colon inflammation, in transplant patients. Discontinuing MMF therapy led to symptom improvement in a reported case.

Keywords:
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Area of Science:

  • Gastroenterology
  • Transplant Medicine
  • Pharmacology

Background:

  • Mycophenolate mofetil (MMF) is a key immunosuppressant for preventing solid organ transplant rejection.
  • MMF-induced colitis is typically diffuse, with segmental involvement being previously unreported.
  • Understanding MMF's gastrointestinal side effects is crucial for patient management.

Observation:

  • A 64-year-old male transplant recipient presented with afebrile diarrhea and abdominal pain.
  • Flexible sigmoidoscopy identified segmental colitis with erythema and ulceration in the sigmoid, descending, splenic flexure, and transverse colon.
  • Biopsies revealed crypt damage, eosinophilic changes, and crypt abscesses indicative of MMF injury.

Findings:

  • This case represents the first reported instance of segmental colitis associated with Mycophenolate mofetil (MMF) use.
  • Histopathological findings confirmed MMF-induced colonic injury.
  • Discontinuation of MMF resulted in significant symptom resolution.

Implications:

  • This report expands the known spectrum of MMF-induced gastrointestinal toxicity.
  • Clinicians should consider MMF as a potential cause of segmental colitis in transplant recipients.
  • Early recognition and MMF withdrawal may prevent severe complications and improve patient outcomes.