Severe hemorrhagic colitis: Complication of mycophenolate mofetil

Backgound: The anti-rejection drug mycofenolate-mofetil (MMF) is known to cause gastrointestinal side-effects. Most often described of these is abdominal pain, nausea, vomiting and bleeding with occasional ulceration and perforation. Colitis is a more infrequent adverse effect, 60 per cent of which is of infectious origin and the rest is thought to be side-effect of MMF

Case report: A case of a 65 year-old female is described in whom MMF was administered for after kidney transplantation. Her past medical history was negative for colonic disease or major ischemic vascular disease.

Five weeks after initiation of therapy she complained of abdominal pain, diarrhea and rectal bleeding was observed. Infectious origin was excluded.

Colonoscopy revealed a severe segmental hemorrhagic pancolitis, more accentuated in the left colon. Histology was suggestive of ulcerative acute colitis showing apoptosis sign of graft-versus-host disease but ischemic type colitis and C. difficile colitis could not either be excluded.

Therapy was suspended and metronidazole administered.

Symptoms slowly regressed and control endoscopy after a month showed complete regression of the colonic pathology.

Discussion: MMF causes non-infectious colitis in 40 per cent of patients with non-febrile diarrhea, a common symptom in MMF-treated patients. It is probably due to a metabolite induced hypersensitivity-autoimmune type reaction and slow spontaneous regression is observed after dose reduction or discontinuation of the agent.