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Journal of Medical Case Reports

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Open Access 01-12-2024 | Mycophenolate Mofetil | Case report

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

Authors: Ziyad Alakkas, Abdulaziz M. Gari, Sara Makhdoum, Eman A. AlSindi

Published in: Journal of Medical Case Reports | Issue 1/2024

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.

Allison AC, Eugui EM. Mycophenolate mofetil and its mechanisms of action. Immunopharmacology. 2000;47(2–3):85–118. https://doi.org/10.1016/s0162-3109(00)00188-0.CrossRefPubMed

Allison AC, Eugui EM. Purine metabolism and immunosuppressive effects of mycophenolate mofetil (MMF). Clin Transplant. 1996;10(1 Pt 2):77–84.PubMed

Tierce JC, Porterfield-Baxa J, Petrilla AA, Kilburg A, Ferguson RM. Impact of mycophenolate mofetil (MMF)-related gastrointestinal complications and MMF dose alterations on transplant outcomes and healthcare costs in renal transplant recipients. Clin Transplant. 2005;19(6):779–84. https://doi.org/10.1111/j.1399-0012.2005.00421.x.CrossRefPubMed

Isaacs PE, Sladen GE, Filipe I. Mefenamic acid enteropathy. J Clin Pathol. 1987;40(10):1221–7. https://doi.org/10.1136/jcp.40.10.1221.CrossRefPubMedPubMedCentral

Gioco R, Puzzo L, Patanè M, Corona D, Trama G, Veroux P, Veroux M. Post-transplant colitis after kidney transplantation: clinical, endoscopic and histological features. Aging (Albany NY). 2020;12(24):24709–20. https://doi.org/10.18632/aging.202345.CrossRefPubMedPubMedCentral

Calmet FH, Yarur AJ, Pukazhendhi G, Ahmad J, Bhamidimarri KR. Endoscopic and histological features of mycophenolate mofetil colitis in patients after solid organ transplantation. Ann Gastroenterol. 2015;28(3):366–73.PubMedPubMedCentral

Bandelier C, Guerne PA, Genevay S, Finckh A, Gabay C. Clinical experience with mycophenolate mofetil in systemic autoimmune conditions refractory to common immunosuppressive therapies. Swiss Med Wkly. 2009;139(3–4):41–6. https://doi.org/10.4414/smw.2009.12441.CrossRefPubMed

Lamba V, Sangkuhl K, Sanghavi K, Fish A, Altman RB, Klein TE. PharmGKB summary: mycophenolic acid pathway. Pharmacogenet Genomics. 2014;24(1):73–9.CrossRefPubMedPubMedCentral

Md Dom ZI, Coller JK, Carroll RP, Tuke J, McWhinney BC, Somogyi AA, et al. Mycophenolic acid concentrations in peripheral blood mononuclear cells are associated with the incidence of rejection in renal transplant recipients. Br J Clin Pharmacol. 2018;84(10):2433–42.CrossRefPubMedPubMedCentral

10.

Lee S, de Boer WB, Subramaniam K, Kumarasinghe MP. Pointers and pitfalls of mycophenolate-associated colitis. J Clin Pathol. 2013;66(1):8–11. https://doi.org/10.1136/jclinpath-2012-200888.CrossRefPubMed

11.

Histological spectrum of mycophenolate mofetil-related colitis: association with apoptosis.

12.

Selbst MK, Ahrens WA, Robert ME, Friedman A, Proctor DD, Jain D. Spectrum of histologic changes in colonic biopsies in patients treated with mycophenolate mofetil. Mod Pathol. 2009;22(6):737–43. https://doi.org/10.1038/modpathol.2009.44.CrossRefPubMed

13.

Mycophenolate mofetil-induced colitis with graft versus host disease-like features in a renal transplant recipient: case report and literature review.

14.

Parfitt JR, Jayakumar S, Driman DK. Mycophenolate mofetil-related gastrointestinal mucosal injury: variable injury patterns, including graft-versus-host disease-like changes. Am J Surg Pathol. 2008;32(9):1367–72. https://doi.org/10.1097/pas.0b013e31816bf3fe.CrossRefPubMed

15.

Al Saadi W, Al Salmi I, Mohammed E, Al Ajmi Z, Hannawi S. Mycophenolate induced colitis: one-year post-kidney transplantation. Oman Med J. 2023;38(2): e489. https://doi.org/10.5001/omj.2023.14.CrossRefPubMedPubMedCentral

16.

Schmitt MM, Ferré EMN, De Melo MS, Cooper MA, Quezado MM, Heller T, Lionakis MS. Mycophenolate-induced colitis in autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy patients. JPGN Rep. 2021;2(4): e131. https://doi.org/10.1097/pg9.0000000000000131.CrossRefPubMedPubMedCentral

17.

Bani Fawwaz BA, Aldwairy A, Farooq A. Mycophenolate-induced colitis: a rare side effect. Cureus. 2021;13(9): e18250. https://doi.org/10.7759/cureus.18250.CrossRefPubMedPubMedCentral

18.

Farooqi R, Kamal A, Burke C. Mycophenolate-induced colitis: a case report with focused review of literature. Cureus. 2020;12(1): e6774. https://doi.org/10.7759/cureus.6774.CrossRefPubMedPubMedCentral

19.

Tayyem O, Saraireh H, Al Hanayneh M, Stevenson HL. Heart transplant recipient with mycophenolate mofetil-induced colitis: the great imitator. BMJ Case Rep. 2018;2018:bcr2017224035. https://doi.org/10.1136/bcr-2017-224035.CrossRefPubMedPubMedCentral

20.

Moroncini G, Benfaremo D, Mandolesi A, Gabrielli A. Mycophenolate mofetil-induced colitis in a patient with systemic sclerosis. BMJ Case Rep. 2018;2018:bcr2018224829. https://doi.org/10.1136/bcr-2018-224829.CrossRefPubMedPubMedCentral

21.

Sonoda A, Wada K, Mizukami K, Fukuda K, Shuto M, Okamoto K, Ogawa R, Okimoto T, Murakami K. Deep ulcers in the ileum associated with mycophenolate mofetil. Intern Med. 2017;56(21):2883–6. https://doi.org/10.2169/internalmedicine.8815-17.CrossRefPubMedPubMedCentral

22.

Dhakal P, Gami R, Giri S, Bhatt VR. Mycophenolate mofetil (MMF)-induced colitis. Blood. 2016;128:4795.CrossRef

23.

Goyal A, Salahuddin M, Govil Y. A unique case of mycophenolate induced colitis after 10 years of use. Case Rep Gastrointest Med. 2016;2016:3058407. https://doi.org/10.1155/2016/3058407.CrossRefPubMedPubMedCentral

24.

Johal K, Ratuapli SK, Lam-Himlin DM, Gurudu SR. Mycophenolate mofetil-induced segmental colitis mimicking ischemic colitis. Case Rep Gastroenterol. 2014;8(1):95–100. https://doi.org/10.1159/000360847.CrossRefPubMedPubMedCentral

25.

Hamouda M, Mahmoudi H, Skhiri H, Elmay M. Mycophenolate mofetil-related pancolitis in a kidney transplant recipient [published correction appears in Exp Clin Transplant. 2012 Aug;10(4):418]. Exp Clin Transplant. 2012;10(5):501–5. https://doi.org/10.6002/ect.2011.0200.CrossRefPubMed

26.

Patra S, Vij M, Sukanya B, Kapoor D. Mycophenolate mofetil-induced colitis with graft versus host disease-like features in a liver transplant recipient. Indian J Pathol Microbiol. 2012;55(4):506–8. https://doi.org/10.4103/0377-4929.107792.CrossRefPubMed

27.

Gorospe EC. Chronic diarrhoea from mycophenolate mofetil-induced colitis. BMJ Case Rep. 2012;2012:bcr2220115344. https://doi.org/10.1136/bcr.12.2011.5344.CrossRef

28.

Bouhbouh S, Rookmaaker MB. Rapid resolution of persistent mycophenolate mofetil-induced diarrhoea with a single dose of infliximab. Nephrol Dial Transplant. 2010;25(10):3437–8. https://doi.org/10.1093/ndt/gfq379.CrossRefPubMed

Title: Mycophenolate-induced colitis in a patient with lupus nephritis: a case report and review of the literature
Authors: Ziyad Alakkas
Abdulaziz M. Gari
Sara Makhdoum
Eman A. AlSindi
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Mycophenolate Mofetil
Lupus Nephritis
Chronic Inflammatory Bowel Disease
Diarrhea
Diarrhea
Graft-Versus-Host Disease
Graft-Versus-Host Disease
Colonoscopy
Published in: Journal of Medical Case Reports / Issue 1/2024
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-024-04539-7

2024 ASCO Annual Meeting

Springer Medicine

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

Abstract

Background

Case presentation

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Case presentation

Conclusion

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