1. GVHD-Like Colitis in Renal Graft Recipient
서울의대 김우호

2. 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

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

9. 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)

10. 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

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

15. 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

17. 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

19. MMF-related GVHD

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