Villous atrophy induced by mycophenolate mofetil in renal-transplant patients

Kamar, Nassim; Fauré, Patrick; DuPuis, E. Melanie; Cointault, Olivier; Joseph-Hein, Karine; Durand, Dominique; Moreau, Jacques; Rostaing, Lionel

doi:10.1007/s00147-004-0745-0

Cited by 47 publications

(28 citation statements)

References 9 publications

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“…Such examples include autoimmune enteropathy,20 bacterial overgrowth,16 common variable immunodeficiency,21 Crohn's disease,22 gastroenteritis,23 giardiasis,24 25 graft versus host disease,26 HIV enteropathy,27 mycobacterium tuberculosis,25 28 peptic duodentitis± H. pylori ,17 29–32 radiation enteritis,33 tropical sprue25 34 and Whipple's disease 35. Medications include non-steroidal anti-inflammatory drugs,36–38 azathioprine,39 methotrexate,40 mycophenolate mofetil41 and, most recently, angiotensin-2-receptor-blockers (A2RBs), in particular olmesartan 16 42–45. Finally, in some instances no unifying cause can be found and such patients are classified as idiopathic/unclassified sprue, the natural history of which is unknown 16 17…”

Section: Introductionmentioning

confidence: 99%

The clinical and phenotypical assessment of seronegative villous atrophy; a prospective UK centre experience evaluating 200 adult cases over a 15-year period (2000–2015)

Aziz

Peerally

Barnes

et al. 2016

Gut

113

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Section: Introductionmentioning

confidence: 99%

The clinical and phenotypical assessment of seronegative villous atrophy; a prospective UK centre experience evaluating 200 adult cases over a 15-year period (2000–2015)

Aziz

Peerally

Barnes

et al. 2016

Gut

113

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“…While immunosuppressed patients may have many explanations for weight loss and growth failure, this may represent an underrecognized complication of MMF toxicity in this at risk group. Histopathologically, the patient described in Case 3 had villous atrophy, a reported gastrointestinal side effect of MMF in adults that has not previously been described in children [11, 12]. This child was also unique in that there were several areas of gastric mucin cell (foveolar) metaplasia seen on small intestinal biopsy specimens, a complication of MMF that has not previously been reported in children and only reported from colonic biopsies in adults [13].…”

Section: Discussionmentioning

confidence: 93%

Mycophenolate Mofetil-Related Enterocolitis and Weight Loss: A Pediatric Case Series

Dykes

Moore²,

Polk³

et al. 2012

Case Reports in Pediatrics

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Mycophenolate mofetil (MMF) is an immunosuppressive medication utilized in the management of both autoimmune and solid organ transplant patients. Diarrhea is a common gastrointestinal side effect of MMF, but more severe forms of GI symptoms are described in renal transplant patients with a distinct pattern of histopathologic change, similar to graft-versus-host disease or Crohn's disease. This rare entity, commonly referred to as “MMF-related enterocolitis,” has been described in adult patients, mostly in renal transplant patients, and in only two pediatric renal transplant patients. In previously reported cases, symptoms and abnormal histopathology improve with dose reduction of MMF. We describe a series of three pediatric patients with varied underlying disease process who presented with severe diarrhea and histopathologic findings characteristic of MMF-related enterocolitis, who share a novel finding of weight loss as a complication of MMF-related enterocolitis in pediatric patients.

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“…However, small intestinal injury has also been reported in association with the chronic use of several medications. Perhaps best known amongst these is the drug-induced villous atrophy associate with the use of mycophenolate mofetil first described in patients post-transplantation [45]. Other medications, including azathioprine and non-steroidal anti-inflammatory drugs, have been described as causing enteropathy, though they are less likely to cause diarrhoea.…”

Section: Miscellaneous Conditionsmentioning

confidence: 99%

Diarrhoea due to small bowel diseases

Murray¹,

Rubio–Tapia²

2012

Best Practice & Research Clinical Gastroenterology

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Small intestinal diseases are a common, though often overlooked cause of diarrhoeal illness. Fully 1% of the Caucasian population are affected by coeliac disease and a substantial portion of children living in poverty in the developing world are affected by environmental enteropathy. These are but two examples of the many diseases that cause mucosal injury to the primary digestive and absorptive organ in our body. While diarrhoea may be a common, though not universally seen symptom of small bowel mucosal disease, the consequent malabsorption can lead to substantial malnutrition and nutrient deficiencies. The small intestine, unlike the colon, has been relatively inaccessible, and systematic evaluation is often necessary to identify and treat small intestinal mucosal diseases that lead to diarrhoea. Immunodeficiency states, including HIV enteropathy, adult autoimmune enteropathy, drug-associated enteropathy, and tropical sprue continue to occur and require specific therapy. All patients with severe diarrhoea or diarrhoea associated with features suggestive of malabsorption may have a disease of the small intestinal mucosa that requires careful evaluation and targeted management.

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Villous atrophy induced by mycophenolate mofetil in renal-transplant patients

Cited by 47 publications

References 9 publications

The clinical and phenotypical assessment of seronegative villous atrophy; a prospective UK centre experience evaluating 200 adult cases over a 15-year period (2000–2015)

The clinical and phenotypical assessment of seronegative villous atrophy; a prospective UK centre experience evaluating 200 adult cases over a 15-year period (2000–2015)

Mycophenolate Mofetil-Related Enterocolitis and Weight Loss: A Pediatric Case Series

Diarrhoea due to small bowel diseases

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