De novo inflammatory bowel disease after pediatric orthotopic liver transplant: a case report.
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.
Dehghani
Seyed Mohsen
SM
Shiraz Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. dehghanism@sums.ac.ir
Eshraghian
Ahad
A
Bahador
Ali
A
Kakaei
Farzad
F
Geramizadeh
Bita
B
Malek-Hosseini
Seyed Ali
SA
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
D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D019804:Mesalamine; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus