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Case Reports
. 2020 Dec 9;7(12):e00496.
doi: 10.14309/crj.0000000000000496. eCollection 2020 Dec.

Autoimmune Gastritis Treated With Mycophenolate Mofetil

Ali H Harb  1 , Roopa Vemulapalli  1 , Purva Gopal  2 , Jason Y Park  2   3
Affiliations
Case Reports

Autoimmune Gastritis Treated With Mycophenolate Mofetil

Ali H Harb et al. ACG Case Rep J. .

Abstract

Autoimmune gastritis is an inflammatory condition of the gastric mucosa. We report a 64-year-old woman with chronic abdominal pain of 3-year duration. Endoscopic and histologic evaluation revealed autoimmune pangastritis. The gastritis was partially responsive to steroids but attempts to taper failed, and the patient had no relief from mercaptopurine, adalimumab, budesonide, or hydroxychloroquine. The patient was treated with mycophenolate mofetil which resulted in resolution of symptoms. Endoscopic and histologic examination after mycophenolate therapy showed near complete resolution of active inflammation. To the best of our knowledge, this is the first report of symptomatic autoimmune gastritis successfully treated by mycophenolate mofetil.

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Figures

Figure 1.
Figure 1.
Initial endoscopy shows severe inflammation with deep ulceration throughout the stomach.
Figure 2.
Figure 2.
Treatment with steroids (prednisone, 5 mg per day) showed some improved, but continued inflammation (gastric body).
Figure 3.
Figure 3.
(A) Gastric biopsies taken while the patient was being treated with steroids show active inflammation, glandular atrophy, and pyloric gland metaplasia; inset shows magnified pyloric gland and active inflammation. (B) Nine-month post–mycophenolate mofetil treatment, the active inflammation has resolved; however, there is continued chronic inflammation. The gastric body shows pyloric and intestinal metaplasia; inset shows intestinal glands with goblet cells.
Figure 4.
Figure 4.
Nine-month post–mycophenolate mofetil treatment, steroids had been tapered and patient was asymptomatic with no endoscopic evidence of ulceration or inflammation (gastric body).
Figure 5.
Figure 5.
The glandular atrophy is no longer complete; there is a re-emergence of occasional glands comprised of parietal and chief cells as shown in the inset.
See this image and copyright information in PMC

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