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Case Reports
. 2020 Jan 25;12(1):e6774.
doi: 10.7759/cureus.6774.

Mycophenolate-induced Colitis: A Case Report with Focused Review of Literature

Rehan Farooqi  1 , Afrin Kamal  2 , Carol Burke  2
Affiliations
Case Reports

Mycophenolate-induced Colitis: A Case Report with Focused Review of Literature

Rehan Farooqi et al. Cureus. .

Abstract

Mycophenolate mofetil (MMF) is an immunosuppressive medication used for the management of various autoimmune diseases, and patients with bone marrow and solid organ transplants. Gastrointestinal side effects are seen 45% of the time and they include nausea (29%), vomiting (23%), constipation (38%), diarrhea (50%-92%), and colitis (9%). In 98% of cases, resolution of diarrhea occurs within 20 days upon discontinuation of the MMF. Data is scarce regarding approach in the treatment of MMF-induced colitis. We report a case of MMF-induced colitis diagnosed by colonoscopy and histopathology. This case illustrates the challenges encountered while managing MMF-induced colitis.

Keywords: colitis; crypt cell apoptosis; drug induced colitis; inflammatory bowel disease (ibd); mycophenolate induced colitis; ulcerative colitis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Magnetic resonance enterography depicting small bowel wall thickening, mural hyper enhancement and peri-enteric stranding involving 10-cm segment of the distal terminal ileum (red arrow)
Figure 2
Figure 2. Colonoscopy
a) depicts ulceration (red arrow) in the ascending colon. b,c) depict ulceration in the distal 15 cm of the neo-terminal ileum (blue and black arrows) with normal-appearing intervening mucosa. d) visualizes anastomosis of the distal ileum (yellow arrow) to the transverse colon (green arrow).
Figure 3
Figure 3. Photomicrograph from the colon biopsy showing architectural distortion with unevenly spaced lumen and crypts
Several damaged crypts (black arrows) are present, scattered throughout the colonic mucosa (hematoxylin and eosin (H&E), original magnification x100). Also present are apoptotic bodies (green arrows) suggestive of cellular injury and turnover (H&E, original magnification x100). There is no evidence of active inflammation or viral cytopathic effect.
Figure 4
Figure 4. Repeat colonoscopy after five days of intravenous steroids showing significant mucosal improvement of the ascending colon (4a - black arrow), and transverse colon (4b - blue arrow)
See this image and copyright information in PMC

References

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