Mycophenolate Induced Colitis: One-year Post-kidney Transplantation

Abstract

The incidence of end-stage kidney disease (ESKD) has been increasing over the past few years as a direct result of the growing percentages of individuals with metabolic syndrome. From 2001 to 2015 there were 2805 individuals diagnosed with ESKD in Oman with a growing number of patients undergoing renal transplant as the gold standard management of renal replacement therapy. Mycophenolate mofetil (MMF) is one of the most frequently used medications as a part of immunosuppressive medications in renal transplant specifically and solid organ transplant generally. We are reporting a case of MMF-induced colitis in a young female patient that underwent a living-related kidney transplant. She presented with a three-month history of watery non-bloody and afebrile diarrhea. Investigations confirmed the diagnosis of MMF-induced colitis. Histopathological examination of colonic biopsies obtained during the colonoscopy procedure showed mildly increased crypt apoptosis, mild architectural disarray, and focal crypt attenuation; features consistent with MMF-induced colitis. The patient was treated by stopping the causative agent and replacing it with another immunosuppressive medication, which led to complete resolution of the symptoms on follow-up appointments. In this case report, we highlighted the underlying mechanism, pathogenesis, and clinical features of MMF-induced colitis.

Keywords: Colitis; Colonoscopy; End-Stage Kidney Disease; Histology; Mycophenolate Mofetil; Transplantation.

Figure 1

Colonic biopsies taken from the sigmoid colon. It showed a mild increased crypt apoptosis, mild architectural disarray, and focal crypt attenuation. This was accompanied by a mild increase in the subepithelial collagen band with focal surface epithelial sloughing. (a) Preserved architecture, magnification = 2 ×. (b) Basal apoptosis, magnification = 40 ×. (c) Thickened subepithelial collagen, magnification = 20 ×. (d) Thickened collagen with epithelial separation, magnification = 20 ×.