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

Farooqi, Rehan; Kamal, A. N.; Burke, Carol A.

doi:10.7759/cureus.6774

Cited by 13 publications

(20 citation statements)

References 19 publications

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“…MMF may cause gastrointestinal side effects including nausea (29%), vomiting (23%), constipation (38%), diarrhoea (50–92%), and colitis (9%) ( 85 ). In 98% of cases, resolution of diarrhoea occurs within 20 days upon discontinuation of the MMF ( 86 ). However, mycophenolate-mofetil–induced colitis is particularly challenging, as it requires a change in the immunosuppressive regimen rather than an increase in immunosuppression and is difficult to distinguish from GvHD even by histopathology ( 87 ), although important to assess for the differential diagnosis ( 88 ).…”

Section: Differential Diagnosis To Agvhdmentioning

confidence: 99%

Current Prophylaxis and Treatment Approaches for Acute Graft-Versus-Host Disease in Haematopoietic Stem Cell Transplantation for Children With Acute Lymphoblastic Leukaemia

et al. 2022

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Acute graft-versus-host disease (aGvHD) continues to be a leading cause of morbidity and mortality following allogeneic haematopoietic stem cell transplantation (HSCT). However, higher event-free survival (EFS) was observed in patients with acute lymphoblastic leukaemia (ALL) and grade II aGvHD vs. patients with no or grade I GvHD in the randomised, controlled, open-label, international, multicentre Phase III For Omitting Radiation Under Majority age (FORUM) trial. This finding suggests that moderate-severity aGvHD is associated with a graft-versus-leukaemia effect which protects against leukaemia recurrence. In order to optimise the benefits of HSCT for leukaemia patients, reduction of non-relapse mortality—which is predominantly caused by severe GvHD—is of utmost importance. Herein, we review contemporary prophylaxis and treatment options for aGvHD in children with ALL and the key challenges of aGvHD management, focusing on maintaining the graft-versus-leukaemia effect without increasing the severity of GvHD.

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Section: Differential Diagnosis To Agvhdmentioning

confidence: 99%

Current Prophylaxis and Treatment Approaches for Acute Graft-Versus-Host Disease in Haematopoietic Stem Cell Transplantation for Children With Acute Lymphoblastic Leukaemia

et al. 2022

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“…The use of MMF as an immunosuppressant is mainly seen in kidney or liver transplant recipients. One of its common side effects is diarrhea, and in about 9% of cases it causes “MMF-induced colitis”[ 31 , 32 ]. This type of colitis presents with IBD-like features of endoscopic and histologic changes in the colon[ 31 ].…”

Section: Drug-induced Secondary Ibdmentioning

confidence: 99%

“…This disease can sometimes persist even after discontinuation of MMF, taking up to 4-6 m for endoscopic resolution[ 34 ]. There have been multiple reported cases of individuals who developed de novo CD after exposure to MMF, followed by improvement of disease after stopping the medication[ 32 , 35 , 36 ]. There was a reported case of rapid resolution of MMF-induced colitis with a single dose of infliximab, suggesting the role of TNF in its pathogenesis[ 37 ].…”

Section: Drug-induced Secondary Ibdmentioning

confidence: 99%

Secondary causes of inflammatory bowel diseases

Ghouri¹,

Tahan²,

Shen³

2020

WJG

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Inflammatory bowel diseases (IBD), conventionally consist of Crohn’s disease (CD) and ulcerative colitis. They occur in individuals with high risk genotype for the disease in the setting of appropriate environmental factors. The pathogenesis of IBD involves a dysregulated autoimmune response to gut dysbiosis, which in turn is triggered due to exposure to various inciting environmental factors. But there is no clearly defined etiology of IBD and this type of disease is termed as “idiopathic IBD”, “classic IBD”, or “primary IBD”. We reviewed the current medical literature and found that certain etiological factors may be responsible for the development of IBD or IBD-like conditions, and we consider this form of de novo IBD as “secondary IBD”. Currently known factors that are potentially responsible for giving rise to secondary IBD are medications; bowel altering surgeries and transplantation of organs, stem cells or fecal microbiome. Medications associated with the development of secondary IBD include; immunomodulators, anti-tumor necrosis factor alpha agents, anti-interleukin agents, interferons, immune stimulating agents and checkpoint inhibitors. Colectomy can in some cases give rise to de novo CD, pouchitis of the ileal pouch, or postcolectomy enteritis syndrome. After solid organ transplantation or hematopoietic stem cell transplantation, the recipient may develop de novo IBD or IBD flare. Fecal microbiota transplantation has been widely used to treat patients suffering from recurrent Clostridium difficile infection but can also causes IBD flares.

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“…Discontinue-and-see approach versus lower the doseand-see approach has been described in literature. Infliximab and/or prednisone have been also used for refractory cases [2,6,7]. An approach to severe diarrhea in renal transplant patients has been described in DIDACT study results [8].…”

Section: Discussionmentioning

confidence: 99%

Mycophenolate-Induced Colitis: A Rare Side Effect

Fawwaz¹,

Al-Dwairy²,

Farooq³

2021

Cureus

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Mycophenolic acid (MPA) is a well-known immunosuppressive medication that is widely used in solid organ transplant recipients. This medication is known to have various gastrointestinal (GI) side effects. Some of those side effects are simple and temporary like nausea; on the other hand, it can also lead to more serious side effects like colitis. We herein report a case of MPA-induced colitis that presented with severe diarrhea. Unexpectedly, the endoscopic appearance of the colon was normal. Moreover, pathology findings were nonspecific. Symptoms had resolved after discontinuation of the medication. MPA-induced colitis is a rare side effect with no established guidelines for management or treatment. Furthermore, the nonspecific endoscopic and microscopic findings make it a diagnostic dilemma.

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

Cited by 13 publications

References 19 publications

Current Prophylaxis and Treatment Approaches for Acute Graft-Versus-Host Disease in Haematopoietic Stem Cell Transplantation for Children With Acute Lymphoblastic Leukaemia

Current Prophylaxis and Treatment Approaches for Acute Graft-Versus-Host Disease in Haematopoietic Stem Cell Transplantation for Children With Acute Lymphoblastic Leukaemia

Secondary causes of inflammatory bowel diseases

Mycophenolate-Induced Colitis: A Rare Side Effect

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