title: Case report: Crohn's-like mycophenolate-induced colitis, a fallout in steroid-free regimens.
abstract: BACKGROUND
  Diarrhea is considered to be a common side effect after renal transplantation, due to a number of infective or drug-related causes. Over the past decade the etiology has perhaps changed with the evolution of immunosuppression. In an attempt to minimize early acute rejection and potential steroid use, the recent introduction of mycophenolic acid-based therapies has increased the incidence of diarrheal symptoms. Histologic and macroscopic appearance of mycophenolate-induced colitis is not well documented.
  
  
  METHODS
  Three patients with immunosuppression-induced colitis had received deceased-donor renal transplantations and presented with diarrhea and/or abdominal pain. All patients made a full recovery after decreasing the dose or withdrawing mycophenolate mofetil or myfortic with corticosteroid-free regimens.
  
  
  CONCLUSIONS
  Patients with immunosuppression-induced colitis require prompt intervention by dose reduction or withdrawal. Both myocophenolate mofetil and myfortic can induce a Crohn's-like colitis even after a long period of exposure. The symptoms may require 6 months to resolve, suggesting that surgery should be considered only as a last resort after a significant period off therapy.
authors.affiliation: Hull York Medical School, University of Hull, Hull, United Kingdom.
authors.forename: A D
authors.initials: AD
authors.lastname: Jakes
authors.forename: A
authors.initials: A
authors.lastname: Roy
authors.forename: M
authors.initials: M
authors.lastname: Veerasamy
authors.forename: S
authors.initials: S
authors.lastname: Bhandari
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D001706:Biopsy; D003424:Crohn Disease / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology; D003967:Diarrhea / Q000139:chemically induced; D057915:Drug Substitution; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid