Mycophenolate Mofetil-Induced Colitis with Graft Versus Host Disease-Like Features in a Renal Transplant Recipient: Case Report and Literature Review

Diarrhoea is a common complication after renal transplant and has a significant impact on quality of life, graft function, and mortality. The main causes of post-transplant diarrhoea are infectious and pharmacological. Mycophenolate mofetil (MMF) is an immunosuppressive medication widely used in kidney transplantation patients. Gastrointestinal side effects of MMF, such as nausea, vomiting, diarrhoea, and abdominal pain, mostly occur during the first months of treatment; however, late-onset diarrhoea does not exclude the diagnosis of MMF-induced colitis. MMF-induced colitis is associated with a wide histological spectrum, including inflammatory bowel disease-like, graft versus host disease-like, and ischaemia-like changes, which may lead to misdiagnosis. The complexity and severity of histological features might explain the variation in treatment response. Given the differences in the therapeutic management and prognosis of these histological changes, it is crucial to consider the diagnosis of MMF-induced colitis. The aim of this paper is to report a rare case of late-onset MMF-induced colitis with graft versus host disease-like features in a renal transplant patient who did not respond to MMF therapy withdrawal, and provide a review of data on this rare complication of immunosuppression.