Mycophenolic Acid (Cellcept and Myofortic) Associated Eosinophilic Enterocolitis in Adult Transplant Recipients
Yao X Schmidt, Jeffrey B Kaplan, Martine C McManus. University of Colorado Denver, Aurora, CO
Background: Mycophenolic acid (Cellcept and Myofortic) is an immunosuppressive drug used in prevention of graft rejection in solid organ transplant recipients. Common gastrointestinal side effects include diarrhea, nausea, vomiting and epigastric pain. The spectrum of histologic changes seen in GI biopsies of patients receiving Mycophenolic acid have been categorized as inflammatory bowel disease-like, graft versus host disease-like, ischemia-like, and self-limited colitis-like. We report eosinophilic enterocolitis as an additional pattern of injury in GI biopsies in symptomatic patients taking Mycophenolic acid.
Design: Five solid organ transplant recipients who were taking Mycophenolic acid and underwent concurrent small intestinal and colon biopsies were identified on a pathology information system search. Of the five patients, 3 were heart transplant recipients, 1 liver and 1 kidney. All patients were symptomatic at biopsy time, and on follow-up, available for all 5 patients, symptoms improved when Mycophenolic acid dose was decreased or withdrawn (1 patient). All patients with IBD, PSC, history of parasitic infection, previously diagnosed GVHD, eosinophilic esophagitis, eosinophilic gastroenterocolitis, celiac sprue, and known food hypersensitivity/allergy were excluded. From these 5 patients, a total of 1 duodenal and 5 colonic biopsies were examined.
Results: Pathologic findings included increased eosinophilic infiltration of the lamina propria, crypt epithelium, and submucosa. The duodenal biopsy showed preserved villous architecture, normal crypt architecture, focally increased lamina propria eosinophilic infiltrates up to 40/HPF, and cryptitis characterized by single cell infiltration of the crypt epithelium by eosinophils. The colon biopsies were taken from all parts of the colon and uniformly showed increased lamina propria eosinophils, ranging from 50-80/HPF in areas of highest density. The biopsies all showed crypt architectural distortion, lamina propria edema, reactive lymphoid hyperplasia, cryptitis similar to that seen in the duodenal biopsy, and occasional eosinophilic crypt abscesses. Two of the colon biopsies additionally showed sheets of eosinophils infiltrating the submucosa. None of the biopsies showed crypt epithelial apoptosis suggestive of GVHD.
Conclusions: Eosinophilic enterocolitis should be included in the spectrum of histologic changes seen in GI biopsies of adult transplant recipients taking Mycophenolic acid.
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 81, Wednesday Morning