Transplant immunology · 2025
Drug-induced acute pancreatitis following dose increase of mycophenolate mofetil in a kidney transplant recipient: A case report and literature review.
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Abou-Jaoude Maroun, Elsidig Ahmed, Abdel-Samad Sara, Tfayli Ibrahim
Аннотация
BACKGROUND: Mycophenolate Mofetil (MMF) is widely used as an immunosuppressive agent in transplant recipients but is rarely associated with acute pancreatitis.
CASE PRESENTATION: We report the case of a 25-year-old male kidney transplant recipient with juvenile cystinosis who developed acute pancreatitis following an increase in MMF dosage from 500 mg to 750 mg twice daily. The patient had previously experienced complications post-transplant, including posterior reversible encephalopathy syndrome and BK virus-related urethral stricture. A recent episode of acute antibody-mediated rejection, confirmed by biopsy, led to the reintroduction and escalation of MMF alongside Tacrolimus. One month later, the patient presented with severe epigastric pain, vomiting, and diarrhea. Laboratory tests revealed markedly elevated lipase levels (2269 U/L), meeting the Atlanta criteria for acute pancreatitis. Imaging excluded alternative etiologies. The patient's symptoms and lipase levels improved immediately after reducing the MMF dose.
CONCLUSION: This case highlights the potential for MMF-induced pancreatitis, particularly following dose escalation, and underscores the importance of cautious dosing and close monitoring in transplant recipients.
CASE PRESENTATION: We report the case of a 25-year-old male kidney transplant recipient with juvenile cystinosis who developed acute pancreatitis following an increase in MMF dosage from 500 mg to 750 mg twice daily. The patient had previously experienced complications post-transplant, including posterior reversible encephalopathy syndrome and BK virus-related urethral stricture. A recent episode of acute antibody-mediated rejection, confirmed by biopsy, led to the reintroduction and escalation of MMF alongside Tacrolimus. One month later, the patient presented with severe epigastric pain, vomiting, and diarrhea. Laboratory tests revealed markedly elevated lipase levels (2269 U/L), meeting the Atlanta criteria for acute pancreatitis. Imaging excluded alternative etiologies. The patient's symptoms and lipase levels improved immediately after reducing the MMF dose.
CONCLUSION: This case highlights the potential for MMF-induced pancreatitis, particularly following dose escalation, and underscores the importance of cautious dosing and close monitoring in transplant recipients.