Successful treatment of ileal ulcers caused by immunosuppressants in two organ transplant recipients
Successful treatment of ileal ulcers caused by immunosuppressants in two organ transplant recipients
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DOI：
10.3748/wjg.v22.i24.5616
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发表时间：
2016-06-28
影响因子：
4.3
通讯作者：
Wei, Xiu-Qing
中科院分区：
文献类型：
--
作者：
Guo, Yun-Wei;Gu, Hua-Ying;Wei, Xiu-Qing
虽然胃十二指肠溃疡在实体器官移植患者中很常见，但免疫抑制剂引起回肠远端和回盲瓣多发性巨大溃疡的报道较少。本文报道了一位肝移植受者和一位肾移植受者在回肠远端和回盲瓣出现多发性大溃疡，在停药西罗莫司或西罗莫司后，溃疡迅速愈合。 他克莫司和沙利度胺的给药。病例1是一名56岁男性，患有原发性肝细胞癌，接受了肝移植。他克莫司联合西罗莫司和泼尼松龙作为抗排斥方案。术后10个月因腹痛、腹泻严重而进行结肠镜检查，发现回盲瓣及回肠远端多发巨大溃疡。停用西罗莫司并用沙利度胺治疗后，溃疡迅速愈合。随访2年未复发。病例2为一名34岁的终末期肾病男性，接受肾移植，并给予他克莫司联合吗替麦考酚酯和泼尼松龙抗排斥治疗。术后12周，患者出现便血和严重贫血。结肠镜检查发现回盲瓣和回肠远端有多处大溃疡，并有大量新鲜血液积聚。静脉注射生长抑素和口服沙利度胺治疗后出血停止。他克莫司同时被撤回。随访第4周时结肠镜检查显示溃疡明显愈合，随访1年未再出现出血。两名患者均未发现淋巴瘤、结核病或巨细胞病毒、EB 病毒或真菌感染。对于远端回肠和回盲瓣溃疡的移植后病例，应将西罗莫司或他克莫司视为可能的危险因素，并停用它们或改用另一种免疫抑制剂
Although gastroduodenal ulcers are common in solid organ transplant patients, there are few reports on multiple giant ulcers in the distal ileum and ileocecal valve caused by immunosuppressants Herein, we report on a liver transplant recipient and a renal transplant recipient with multiple large ulcers in the distal ileum and ileocecal valve who rapidly achieved ulcer healing upon withdrawal of sirolimus or tacrolimus and administration of thalidomide. In case 1, a 56-year-old man with primary hepatocellular carcinoma had received a liver transplantation. Tacrolimus combined with sirolimus and prednisolone was used as the anti-rejection regimen. Colonoscopy was performed because of severe abdominal pain and diarrhea at postoperative month 10. Multiple giant ulcers were found at the ileocecal valve and distal ileum. The ulcers healed rapidly with withdrawal of sirolimus and treatment with thalidomide. There was no recurrence during 2 years of follow-up. In case 2, a 34-year-old man with end-stage kidney disease received kidney transplantation and was put on tacrolimus combined with mycophenolate mofetil and prednisolone as the anti-rejection regimen. Twelve weeks after the operation, the patient presented with hematochezia and severe anemia. Colonoscopy revealed multiple large ulcers in the ileocecal valve and distal ileum, with massive accumulation of fresh blood. The bleeding ceased after treatment with intravenous somatostatin and oral thalidomide. Tacrolimus was withdrawn at the same time. Colonoscopy at week 4 of follow-up revealed remarkable healing of the ulcers, and there was no recurrence of bleeding during 1 year of follow-up. No lymphoma, tuberculosis, or infection of cytomegalovirus, Epstein-Barr virus, or fungus was found in either patient. In post-transplantation cases with ulcers in the distal ileum and ileocecal valve, sirolimus or tacrolimus should be considered a possible risk factor, and withdrawing them or switching to another immunosuppressant