Diffuse colitis during mycophenolate mofetil treatment: a case report.

Mycophenolate mofetil (MMF) or Cellcept(R) is a potent immunosuppressor that inhibits purin synthesis used to prevent human allograft rejection. The most important secondary effects include haematological and intestinal disorders. Among them, diarrhea is the most common. It is dose-dependant and appears commonly during the first 2 months of treatment. Its physiopathology remains unclear. We reported a case of colitis, 6 months after a kidney transplantation. The patient was treated since day 2 with 2 grams per day of MMF. Morphological analysis showed a diffuse colitis from the coecum to the rectum. Histological samples confirmed a colitis with atrophic crypts but with mucosal secretions and same cryptic abscesses. No granuloma or CMV inclusion was founded. Histochemical immunostaining for CMV was negative. Finally, symptoms regressed within 5 days after tapering down MMF dose in association with metronidazole treatment. The role of MMF in inducing colitis is discussed.