De-novo [corrected] post renal transplantation inflammatory bowel disease.
Post-renal transplant de-novo inflammatory bowel disease (IBD) may develop despite the presence of mycophenolate mofetil (MMF), a drug used for treatment of IBD, in the immunosuppressive regimen. A 39-year-old man received live unrelated renal transplant, and was started postoperatively on prednisolone, MMF, and tacrolimus, which was changed to sirolimus when he developed diabetes mellitus two months post-transplant. Nine months post-transplant, the patient developed recurrent attacks of bloody diarrhea and ischio-rectal abscesses complicated by anal fistulae not responding to routine surgical treatment. Colonoscopy diagnosed IBD, a Crohn's disease-like pattern. The patient was treated with steroids and 5-aminosalicylic acid (5-ASA) in addition to a two months course of ciprofloxacin and metronidazole. He became asymptomatic and rectal lesions healed within one month of treatment. The patient continued to be asymptomatic, and he maintained normal graft function on the same immunosuppressive treatment in addition to 5-ASA. We conclude that de-novo IBD disease can develop in renal transplant recipients in spite of immunosuppressive therapy including MMF.
Halim
M A
MA
Hamed Al Essa Organ Transplantation Centre, Kuwait. medhatmohamed2000@yahoo.com
Al-Otaibi
T
T
Elsisi
A
A
El-Sayed
A
A
Nair
P
P
Said
T
T
Balaha
M A
MA
Nampoory
M R N
MR
D000328:Adult; D000636:Aminosalicylic Acids / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D020123:Sirolimus / Q000627:therapeutic use; D016896:Treatment Outcome
D000636:Aminosalicylic Acids; D007166:Immunosuppressive Agents; D008795:Metronidazole; D002939:Ciprofloxacin; D009173:Mycophenolic Acid; D020123:Sirolimus