title: Not your usual diarrhoea: severe colonic toxicity of mycophenolate due to intestinal CMV and EBV infection.
abstract: We report a case of a 52-year-old woman, on immunosuppressive treatment with mycophenolate due to a history of giant cell myocarditis (GCM), who presented with new-onset severe blood-tinged diarrhoea after a cytomegalovirus (CMV) primoinfection. An extensively prolonged mycophenolate-related colitis was seen after withdrawal of mycophenolate due to an intestinal Epstein-Barr virus (EBV) infection-a rarely seen event itself. We postulate that colonic toxicity was triggered by CMV infection and perpetuated by intestinal EBV replication/infection.
authors.affiliation: Department of Medicine, University Hospital of Basel, Basel, Switzerland.
authors.forename: Heike
authors.initials: H
authors.lastname: Seifert
authors.forename: Christoph
authors.initials: C
authors.lastname: Hess
authors.forename: Luici
authors.initials: L
authors.lastname: Terracciano
authors.forename: Jens
authors.initials: J
authors.lastname: Eckstein
mesh_terms: D003092:Colitis / Q000139:chemically induced* / Q000209:etiology; D003586:Cytomegalovirus Infections / Q000150:complications*; D003967:Diarrhea / Q000139:chemically induced*; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000633:toxicity*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000633:toxicity; D012720:Severity of Illness Index
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid