Mycophenolate-induced colitis in a patient with lupus nephritis: a case report and review of the literature

Abstract

Background: Mycophenolate mofetil (MMF) is an immunosuppressive drug that is frequently prescribed to patients with rheumatological diseases. MMF's side effects include abdominal discomfort, nausea, vomiting, and other gastro-intestinal side effects, which typically appear in the first few months of treatment. However, late-onset diarrhea does not rule out the presence of MMF-induced colitis, which can be misdiagnosed since it is linked to a broad range of histopathological characteristics, including alterations that resemble inflammatory bowel disease, graft-versus-host disease, and ischemia. The differences in treatment response may be explained by the complexity of the histopathologic characteristics.

Case presentation: Here we present a case of a 29-year-old Arabian female with lupus nephritis who started on MMF as induction therapy. In two months, the patient was presented to the Emergency Department with diarrhea and manifestations of severe dehydration. Infectious diseases and adverse drug events were suspected, so the patient was admitted for further workup, and MMF was stopped. The patient was diagnosed with MMF-induced colitis based on colonoscopy and histological findings. Fourteen days after stopping MMF, she was within her baseline.

Conclusion: The purpose of this paper is to report a case of early-onset MMF-induced colitis in a patient with lupus nephritis who had started MMF as induction therapy. A review of the available literature on this uncommon immunosuppressive effect is also presented.

Keywords: Case report; Colitis; MMF; Mycophenolate mofetil.

Fig 1

Colonoscopy shows hyperemic mucosa with some superficial ulcers from sigmoid up to the cecum, while the terminal ileum shows superficial ulceration with some area of inflammatory patches

Fig. 2

Mycophenolate Mofetil induced colitis. A Colonic biopsy with mild architectural distortion, crypt hyperplasia and lamina propria inflammation (HEx 4 ×). B Higher magnification (HE 20 ×) show dilated colonic glands. C Destructed ruptured colonic glands with mucin spillage (HE × 20 ×). D Acute inflammation within the glands (cryptitis), at high power magnification (HE x 40 ×)