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Severe Enteropathy From Mycophenolate Mofetil

Asad Jehangir1, Bilal Shaikh1, Jettie Hunt2

  • 1Department of Internal Medicine, Reading Health System, West Reading, PA.

ACG Case Reports Journal
|March 10, 2016
PubMed

Insights

Mycophenolate mofetil can cause rare small intestine issues, leading to diarrhea and weight loss. Switching to enteric-coated mycophenolic acid resolved these adverse effects in a renal transplant patient.

Area of Science:

  • Gastroenterology
  • Nephrology
  • Pharmacology

Background:

  • Mycophenolate mofetil (MMF) is an immunosuppressant commonly used post-renal transplant.
  • Adverse gastrointestinal effects of MMF, particularly colitis, are well-documented.
  • Isolated small intestinal involvement is less frequently reported.

Observation:

  • A 45-year-old female renal transplant recipient on MMF presented with abdominal pain and significant weight loss.
  • Initial upper endoscopy and colonoscopy with biopsies were unremarkable.
  • Small bowel capsule endoscopy and push enteroscopy revealed extensive enteropathy affecting the jejunum and ileum.

Findings:

  • The patient's symptoms of diarrhea and weight loss were attributed to MMF-induced enteropathy.
  • Biopsies confirmed inflammation and damage within the small intestine.
  • Discontinuation of MMF and transition to enteric-coated mycophenolic acid (EC-MPA) led to complete symptom resolution.

Implications:

  • This case highlights the potential for MMF to cause isolated small intestinal toxicity.
  • EC-MPA may represent a safer alternative for patients experiencing MMF-induced enteropathy.
  • Clinicians should consider small bowel evaluation in transplant patients on MMF presenting with unexplained gastrointestinal symptoms and weight loss.

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