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VILLOUS ATROPY: CELIAC DISEASE OR COMPLICATION OF MYCOPHENOLATE MOFETIL
A Morse, S van Zantan
University of Alberta, Division of Gastroenterology, Edmonton, Alberta
Aims: Mycophenolate mofetil (MMF) is a commonly used immunosuppressant which inhibits purine synthesis. One of its main side-effects is diarrhea, the mechanism of which is not well understood. Cases with associated small bowel villous atrophy and erosive enterocolitis have been reported (Kamar et al 2004, Berribi et al 2000, Maes et al 2003, Didier et al 1998). Celiac disease is a recognized cause of diarrhea with a prevalence estimated at 1% of the population.
Methods: This case reviews an unusual presentation of a new case of Celiac disease.
Results: This type I diabetic patient presented with a diarrheal illness that started after initiation of MMF for immunosuppression post renal transplantation. Diagnosis of Celiac disease was made after positive tissue transglutaminase testing, duodenal biopsy and HLA typing even though diarrhea completely subsided after withdrawal of MMF.
Conclusions: This case emphasizes that common disease can manifest itself in unusual ways.
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