De-novo [corrected] post renal transplantation inflammatory bowel disease

Saudi J Kidney Dis Transpl. 2008 Jul;19(4):624-6.

Abstract

Post-renal transplant de-novo inflammatory bowel disease (IBD) may develop despite the presence of mycophenolate mofetil (MMF), a drug used for treatment of IBD, in the immunosuppressive regimen. A 39-year-old man received live unrelated renal transplant, and was started postoperatively on prednisolone, MMF, and tacrolimus, which was changed to sirolimus when he developed diabetes mellitus two months post-transplant. Nine months post-transplant, the patient developed recurrent attacks of bloody diarrhea and ischio-rectal abscesses complicated by anal fistulae not responding to routine surgical treatment. Colonoscopy diagnosed IBD, a Crohn's disease-like pattern. The patient was treated with steroids and 5-aminosalicylic acid (5-ASA) in addition to a two months course of ciprofloxacin and metronidazole. He became asymptomatic and rectal lesions healed within one month of treatment. The patient continued to be asymptomatic, and he maintained normal graft function on the same immunosuppressive treatment in addition to 5-ASA. We conclude that de-novo IBD disease can develop in renal transplant recipients in spite of immunosuppressive therapy including MMF.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aminosalicylic Acids / therapeutic use
  • Ciprofloxacin / therapeutic use
  • Crohn Disease / drug therapy
  • Crohn Disease / etiology
  • Crohn Disease / pathology
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Inflammatory Bowel Diseases / drug therapy
  • Inflammatory Bowel Diseases / etiology*
  • Inflammatory Bowel Diseases / pathology
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / immunology
  • Male
  • Metronidazole / therapeutic use
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Sirolimus / therapeutic use
  • Treatment Outcome

Substances

  • Aminosalicylic Acids
  • Immunosuppressive Agents
  • Metronidazole
  • Ciprofloxacin
  • Mycophenolic Acid
  • Sirolimus