title: De novo inflammatory bowel disease after pediatric orthotopic liver transplant: a case report.
abstract: OBJECTIVE
  The improvement of pre-existing inflammatory bowel disease after orthotopic liver transplant might be anticipated. However, both the exacerbation of inflammatory bowel disease and de novo inflammatory bowel disease after orthotopic liver transplant (despite sufficient allograft immunosuppressive therapy) have been described.
  
  
  METHODS
  We present a case of ulcerative colitis in a pediatric liver transplant recipient.
  
  
  RESULTS
  A 13-year-old boy with cryptogenic liver cirrhosis received an orthotopic liver transplant from a deceased donor. Five months later, he presented with watery diarrhea and abdominal distention. He was treated with the immunosuppressive agents tacrolimus (0.15 mg/kg/d) and mycophenolate mofetil (20 mg/kg/d). A general physical examination revealed a boy with stable vital signs and without fever. The only positive finding was enlargement of the abdomen without tenderness. Many pus cells and a few red blood cells were detected in the patient's stool, but the results of a stool culture for bacteria were negative. Because of his chronic diarrhea, this patient underwent colonoscopy, which revealed diffuse erythematous mucosa, multiple ulcers, exudate, and pseudopolyps with a diffuse loss of vascularity. Those findings are indicators of colitis. The results of histopathologic examination of the colonic mucosa suggested ulcerative colitis. The patient was treated with mesalamine and prednisolone, and a repeat colonoscopy revealed an improvement in his bowel disease.
  
  
  CONCLUSIONS
  De novo inflammatory bowel disease should be considered in patients in whom chronic diarrhea develops after an orthotopic liver transplant. We suggest that colonoscopy and biopsy should always be performed if other causes of diarrhea have been excluded.
authors.affiliation: Shiraz Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. dehghanism@sums.ac.ir
authors.forename: Seyed Mohsen
authors.initials: SM
authors.lastname: Dehghani
authors.forename: Ahad
authors.initials: A
authors.lastname: Eshraghian
authors.forename: Ali
authors.initials: A
authors.lastname: Bahador
authors.forename: Farzad
authors.initials: F
authors.lastname: Kakaei
authors.forename: Bita
authors.initials: B
authors.lastname: Geramizadeh
authors.forename: Seyed Ali
authors.initials: SA
authors.lastname: Malek-Hosseini
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001706:Biopsy; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D003106:Colon / Q000187:drug effects / Q000473:pathology*; D003113:Colonoscopy; D003967:Diarrhea / Q000209:etiology; D004359:Drug Therapy, Combination; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007413:Intestinal Mucosa / Q000473:pathology; D008103:Liver Cirrhosis / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D019804:Mesalamine; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus