title: Nodular hyperplasia of the gastrointestinal tract after liver transplantation: role of immunosuppressive therapy? A case report.
abstract: Nodular lymphoid hyperplasia (NLH) of the gastrointestinal tract is a rare disease usually reported in patients with congenital or acquired immunodeficiency and chronic gastrointestinal infections. However, no case of NLH in a patient receiving immunosuppressive therapy has been reported to date. We describe the case of a woman who developed chronic diarrhea related to NLH 9 years after liver transplantation. Other causes of diarrhea and NLH were excluded. Her immunosuppressive regimen consisted on mycophenolate mofetil (MMF) and tacrolimus. Reduction of MMF dose improved symptoms but led to a rising aminotransferase level. Given the risk of graft rejection, MMF at full dose was resumed and she was started on symptomatic treatment for diarrhea. The role of immunosuppressive drugs in the pathogenesis of NLH may be related to the reduction of T- and B-lymphocyte proliferation and decreasing antibody production. NLH will further develop to compensate functionally inadequate lymphoid tissue, as reported in congenital immunodeficiency states.
authors.affiliation: Department of Hepatogastroenterology, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia. Electronic address: rym.ennaifer@yahoo.fr.
authors.forename: R
authors.initials: R
authors.lastname: Ennaifer
authors.affiliation: Department of Pathology, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia.
authors.forename: S
authors.initials: S
authors.lastname: Ben Slama
authors.affiliation: Department of Hepatogastroenterology, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia.
authors.forename: H
authors.initials: H
authors.lastname: Romdhane
authors.affiliation: Department of Surgery, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia.
authors.forename: R
authors.initials: R
authors.lastname: Bayar
authors.affiliation: Department of Hepatogastroenterology, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia.
authors.forename: M
authors.initials: M
authors.lastname: Cheikh
authors.affiliation: Department of Hepatogastroenterology, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia.
authors.forename: H
authors.initials: H
authors.lastname: Ben Nejma
authors.affiliation: Department of Surgery, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia.
authors.forename: H
authors.initials: H
authors.lastname: Mestiri
authors.affiliation: Department of Hepatogastroenterology, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia.
authors.forename: N
authors.initials: N
authors.lastname: Bel Hadj
mesh_terms: D003967:Diarrhea / Q000209:etiology; D004386:Duodenum / Q000473:pathology; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000473:pathology*; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D006965:Hyperplasia; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007413:Intestinal Mucosa / Q000473:pathology; D016031:Liver Transplantation; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D011183:Postoperative Complications / Q000473:pathology*; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus