Mycophenolate mofetil

Abstract

Mycophenolate mofetilEpistaxis, haematochezia and pancytopenia: case report A 35-year-old man developed epistaxis, haematochezia and pancytopenia during treatment with mycophenolate mofetil for Henoch-Schonlein purpura (HSP).The man, who had a history of schizoaffective disorder, was hospitalised due to a bilateral, palpable, nontender rash on his legs with leg stiffness and leg pain. Subsequent investigations revealed HSP. He started receiving prednisone with improvement. However, in the subsequent week, his symptoms worsened with oliguria, rapid increase in serum creatinine and nephrotic-range proteinuria. He received methylprednisolone for three days. Dialysis was initiated. Additionally, he started receiving oral mycophenolate mofetil 1g twice daily. Due to suspicion of a paraneoplastic syndrome, partial nephrectomy was performed. Subsequent investigations revealed a clear cell renal cell carcinoma pT1b with HSP nephritis. On the post-nephrectomy day 8, he was discharged. After two weeks, he was admitted again due to shortness of breath and increased creatinine. A leak was noted in his nephrectomy wound, causing oliguria. The kidney tumour was surgically removed. He underwent repeat renal biopsy, which showed diffuse cellular and fibrocellular crescents and minimal IgA deposition along glomerular capillary wall. He was initiated on therapeutic plasma exchange. Cyclophosphamide [cytoxan] was added to his treatment and he was discharged. Several days after the discharge, he developed epistaxis, haematochezia and pancytopenia which were suspected to be secondary to mycophenolate mofetil [time to reaction onsets not clearly stated].The man's treatment with mycophenolate mofetil was discontinued. Subsequently, prednisone and cyclophosphamide were stopped and only renal replacement therapy was continued [reaction outcomes not stated].