GVHD-Like Colitis in Renal Graft Recipient 서울의대 김우호

증례 36세 남자 주소: 설사, 하루 10회 과거력: 10년전 신장이식 약물 검사실소견: Cyclosporin A, Mycophenolate mofetil, Prednisolone 검사실소견: CMV IgM(-), CMV IgG (-) CMV Ag (-), Cyclosporin A: 참고치이하

대장내시경 proximal – distal colon에서 mucosal edema와 submucosal vascularity의 소실이 있었으나 궤양이나 미란의 소견은 없었다.

Diagnosis Chronic active colitis with Crypt atrophy Cryptitis Acute inflammatory cells in lamina propria Single cell apoptosis in crypt base Histologically consistent with graft-versus-host disease (GVHD)

GVHD Response of competent donor to histocompatibility antigen Bone marrow transplantation Transfusion of blood or blood products Maternal-fetal cell transfer in immunodefiency children Malignant thymoma

GVHD Targets and symptoms Skin-rash GI (70%)-nausea, vomiting, diarrhea, ileus, cramping pain, malabsorption Biliary-jaundice Bone marrow Lymphoid tissue

Lesions Resembling GVHD Malignancy Thymoma Malignant lymphoma Hodgkin’s disease Leukemia Immunodeficiency AIDS Combined immunodeficiency Severe T-cell deficiency Autoimmune disease Infection Salmonella CMV Cytotoxic Radiation Chemotherapy Others NSAID

Mycophenolate Mofetil (MMF) RS-61443 Approved 1995 Maintenance immunosuppression drug Significantly decrease acute rejection Suppress B and T cell by inhibiting inosine monophosphate dehydrogenase GI toxicity; diarrhea

MMF-related GVHD

MMF-related colitis MMF-related colitis should be considered MMF intake Diarrhea Histologic features similar to GVHD No evidence of CMV No skin lesion