Development of ulcerative colitis after heart transplantation during immunosuppressive therapy.
BACKGROUND
Cardiac transplantation has become an accepted treatment modality for end-stage heart failure. Immunosuppressive agents, which are used after transplantation, are considered as therapeutic options for inflammatory bowel disease.


METHODS
We report on a 53-year-old patient who was treated for 2 years with cyclosporine A, azathioprine and prednisolone after heart transplantation. He developed a distal colitis with all features of ulcerative colitis. An infectious or ischemic etiology was carefully excluded. In spite of high-dose treatment with prednisolone the patient's abdominal symptoms worsened and he developed a progression of the inflammation in the entire colon and a colectomy with ileostomy was necessary. The histology was consistent with ulcerative colitis. After colectomy he recovered and remained in a good state of health.


CONCLUSIONS
This report supports the concept that new onset inflammatory bowel disease can develop in a heart transplantation recipient in spite of immunosuppression.
Jüngling
B
B
Department of Internal Medicine II, Saarland University, Germany.
Kindermann
I
I
Moser
C
C
Püschel
W
W
Ecker
K W
KW
Schäfers
H J
HJ
Böhm
M
M
Zeuzem
S
S
Giese
T
T
Stallmach
A
A
D001706:Biopsy; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003113:Colonoscopy; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007081:Ileostomy; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007413:Intestinal Mucosa / Q000473:pathology; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D012086:Reoperation
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone