Pointers and pitfalls of mycophenolate-associated colitis

Lee, Stephen; Boer, W. Bastiaan de; Subramaniam, Kavitha; Kumarasinghe, M. Priyanthi

doi:10.1136/jclinpath-2012-200888

Cited by 69 publications

(36 citation statements)

References 9 publications

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“…1d, inset 2) leading to the diagnosis of CMV infection. In line with our observations, in a recently published study on MPA-associated colitis, Lee et al [11] describe dual pathology in 3 of 7 cases, 2 of which were with concomitant CMV infection. Their findings and our own observations support the notion that patients on MPA treatment do indeed have a higher risk of developing dual or multiple pathologies.…”

Section: Mpa-induced Colonopathy With Multiple Pathologiessupporting

confidence: 78%

“…As illustrated in figure 1a, the different histopathological key findings are best evaluated on low-power view (architecture, left), medium-power view (epithelial changes, middle) and high-power view (apoptosis, right), respectively. Whereas none of the above-mentioned findings is specific for MPA, the simultaneous observation of a mixed pattern of injury (architectural distortion, increased number of crypt cell apoptosis, epithelial changes with cystically dilated crypts) is characteristic for MPA toxicity [6,10,11,12]. Variably encountered additional findings are an increased number of eosinophils in the lamina propria and a (relatively) increased number of neuroendocrine cells which seem to be less prone to undergo apoptosis.…”

Section: Mpa-induced Colonopathymentioning

confidence: 99%

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Apoptotic Colonopathy under Immunosuppression: Mycophenolate-Related Effects and Beyond

Weber¹,

Marques-Maggio²

2013

Pathobiology

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Background/Aims: Diarrhea developing in patients under immunosuppression has a variety of underlying causes. A broad spectrum of histological findings can be found in intestinal biopsies taken for the diagnostic workup of diarrhea including a pathologically increased proportion of epithelial cell apoptosis in the colon, for which the descriptive term ‘apoptotic colonopathy' was coined. In recent years, the immunosuppressive drug mycophenolate (mycophenolic acid, MPA) has been identified as a prototypical cause of apoptotic colonopathy, but other conditions may show similar or overlapping histological pictures. Methods: Cases of likely or possible MPA colonopathy (n = 18) were retrospectively identified from the archive files. Clinical information on patient history, clinical presentation and endoscopic findings were recorded. All cases were routinely processed, i.e. stained by hematoxylin and eosin (HE) stain, optionally supplemented by special histochemical and immune stains. Results and Conclusion: Histopathological hallmarks of MPA treatment-related changes in the colon mucosa are reviewed with respect to the major histopathological differential diagnoses including normal and near-normal findings, infectious diseases, graft-versus-host disease and inflammatory bowel diseases. Furthermore, the challenge of multiple concomitant pathologies while on MPA treatment, in particular infectious diseases, is discussed, and some open questions concerning the effects of MPA on colon pathology are pointed out.

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Section: Mpa-induced Colonopathy With Multiple Pathologiessupporting

confidence: 78%

Section: Mpa-induced Colonopathymentioning

confidence: 99%

Apoptotic Colonopathy under Immunosuppression: Mycophenolate-Related Effects and Beyond

Weber¹,

Marques-Maggio²

2013

Pathobiology

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“…Symptoms and histopathologic abnormalities may improve when mycophenolate mofetil is substituted with another immunosuppressive drug. [13][14][15] In summary, the present kidney transplant recipient had acute colonic pseudo-obstruction that persisted despite several commonly used treatments. He improved only after discontinuation of mycophenolate mofetil.…”

Section: Discussionmentioning

confidence: 75%

Untitled

Al-Mueilo

Alsulaiman²

2015

Exp Clin Transplant

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Mycophenolate mofetil is a component of immunosuppressive regimens in solid-organ transplant recipients. Gastrointestinal symptoms such as nausea, abdominal pain, and diarrhea without fever are common in patients treated with mycophenolate mofetil. We treated a patient who had acute colonic pseudo-obstruction after kidney transplant that resolved after discontinuing mycophenolate mofetil. The disorder recurred soon after resuming mycophenolate mofetil, which is evidence for an association between mycophenolate mofetil and acute colonic pseudo-obstruction in this patient.

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“…The following scoring system was used: none/minimal (−), rare/focal (+), numerous/strong (++). Dilated damaged crypts were defined as cystically dilated crypts with flattened degenerated epithelium containing apoptotic debris and few neutrophils 3 9. Also recorded was the presence of intraepithelial lymphocytes, chronic inflammatory cells in the lamina propria and mucosal ulcerations.…”

Section: Methodsmentioning

confidence: 99%