Mycophenolate-mofetil/prednisolone/tacrolimus
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Mycophenolate-mofetil/prednisolone/tacrolimus Cytomegalovirus papillitis and cholangiopathy: case report
A 65-year-old man developed cytomegalovirus (CMV) papillitis and cholangiopathy during immunosuppressive treatment with mycophenolate mofetil, prednisolone and tacrolimus [routes and dosages not stated]. The man, who had diabetes mellitus, had undergone renal transplantation seven years previously and had been receiving mycophenolate mofetil, prednisolone and tacrolimus immunosuppression. Later, he presented with epigastric pain, nausea, vomiting, heartburn, anorexia, diarrhoea and 10kg of weight loss over a period of three month. He was admitted. Mild tenderness and a scar from the previous transplant were observed on the upper abdomen during an examination. Investigations showed elevated levels of alkaline phosphatase and γ-glutamyl transferase. Hepatitis B-antigen was found to be positive. A PCR for CMV was negative. CT scan revealed dilated intra and extrahepatic biliary radicals along with a soft tissue mass at the ampulla of vater. An endoscopic retrograde cholangiopancreatography revealed papillary mass and distal common bile duct stricture. Histopathological analysis of the papillary mass indicated CMV infection. Based on these findings, a diagnosis of papillitis and cholangiopathy was made. The man was treated with valganciclovir. His clinical condition improved and he was discharged. Madkhali A, et al. Cytomegalovirus papillitis and cholangiopathy in renal transplant patients. Kuwait Medical Journal 52: 81-84, No. 1, Mar 2020
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Reactions 19 Sep 2020 No. 1822
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