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Davies NM, Grinyo J, Heading R, et al. Gastrointestinal side effects of mycophenolic acid in renal transplant patients: a reappraisal. Nephrol Dial Transplant 2007; 22: 2440-2448.

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Article

Mycophenolate-Associated Sprue-Like Intestinal Disease Evolving into Collagenous Sprue

1Departments of Medicine (Gastroenterology) and Pathology, University of British Columbia, Vancouver, BC, Canada


International Journal of Celiac Disease. 2021, Vol. 9 No. 2, 38-40
DOI: 10.12691/ijcd-9-2-5
Copyright © 2021 Science and Education Publishing

Cite this paper:
Hugh James Freeman, Michael Nimmo. Mycophenolate-Associated Sprue-Like Intestinal Disease Evolving into Collagenous Sprue. International Journal of Celiac Disease. 2021; 9(2):38-40. doi: 10.12691/ijcd-9-2-5.

Correspondence to: Hugh  James Freeman, Departments of Medicine (Gastroenterology) and Pathology, University of British Columbia, Vancouver, BC, Canada. Email: hugfree@shaw.ca

Abstract

A 43-yr old female with two prior renal transplants for renal failure associated with diabetes, retinopathy and coronary artery disease developed diarrhea. Her medications included mycophenolate mofetil, an immunosuppressive medication documented to cause sprue-like mucosal changes in the small intestine. Later studies revealed a small intestinal mucosal lesion characterized by marked crypt hyperplasia, villous atrophy and increased intra-epithelial lymphocytes. Serological studies for celiac disease were negative and repeated biopsies despite a strict gluten-free diet, revealed histopathological persistence of a severely abnormal sprue-like enteropathy. Eventually, further biopsies of her small intestine revealed superimposed changes characterized by dense sub-epithelial collagen deposits histochemically staining positive for trichrome, typical of collagenous sprue and representing an expansion of published pathological features of mycophenolate-associated small intestinal mucosal disease.

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