Reactions 1680, p248 - 2 Dec 2017
Gastrointestinal toxicity: case report
A 54-year-old man developed gastrointestinal (GI) toxicity
during treatment with mycophenolate mofetil.
The man had undergone living donor kidney transplant,
following which, therapy with mycophenolate mofetil 1 g/day
[route not stated], methylprednisolone and tacrolimus was
initiated. He had also undergone cholecystectomy at the age of
44 years. Two years following the transplant, he developed
watery diarrhoea occurring 5
6 times per day. Multiple deep
ulcers in the ileum were revealed by ileocolonoscopy.
Pathological findings demonstrated mild crypt distortion.
Interferon γ-release assays were positive. CMV-C7HRP-
positive cells were present at only one cell per 5 × 10
peripheral blood leucocytes were present in his serum. Based
on the form of ulcers, CMV infection was suspected.
The man received treatment with valganciclovir. However, it
was ineffective and the symptoms worsened. On day 22 of
valganciclovir therapy, he was admitted to hospital. His
diarrhoea had worsened to more than 10 times/day. A highly
elevated C-reactive protein (CRP) level was revealed by
laboratory data. CMV-C7HRP was negative. His CRP level and
symptoms improved after receiving total parenteral nutrition.
On day 24, the ulcers increased in size and bloody stools were
observed. Valganciclovir therapy was changed to ganciclovir.
His symptoms and CRP levels worsened after the initiation of
oral feeding on day 29. The ileal ulcers grew larger and deeper
on day 32. He was diagnosed with GI toxicity due to
mycophenolate mofetil [duration of therapy to reaction onset
not stated]. His therapy with mycophenolate mofetil was
changed to mizoribine. An immediate improvement in his
symptoms was observed. His CRP levels returned to normal.
After six months, the mucosa of the ileum healed.
Author comment: "The patient was subsequently
diagnosed with gastrointestinal toxicity of [mycophenolate
mofetil] and [mycophenolate mofetil] was switched to
Sonoda A, et al. Deep ulcers in the ileum associated with mycophenolate mofetil.
Internal Medicine 56: 2883-2886, No. 21, 01 Nov 2017. Available from: URL:
http://doi.org/10.2169/internalmedicine.8815-17 - Japan
Reactions 2 Dec 2017 No. 16800114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved