Mycophenolic acid
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Mycophenolic acid Massive ascites: case report
A 31-year-old woman developed massive ascites during treatment with mycophenolic acid [route, dosage and duration of treatment to reaction onset not stated] as immunosuppressant therapy. The woman, who had a history of two kidney transplants, was hospitalised in 2018 due to growing ascites. She developed ascites four years after the second kidney transplantation. Anamneses revealed that she was diagnosed with renal failure in 2008, and she underwent a first kidney transplant in 2009. However, in 2011, she developed acute T cell-mediated rejection and component antibody-mediated rejection. In spite of treatment with thyroglobulin, methylprednisolone and peritoneal dialysis, she underwent a second kidney transplant in 2014. In 2015, she again developed antibody-mediated rejection, which was successfully treated with immune globulin and methylprednisolone. At the current presentation (in 2018), she underwent paracentesis every 2–3 weeks because of increasing ascites. At the time of the procedure, approximately 8–10L of fluid was drained, which were tested negative for various infections. The peritoneal fluid cytology revealed a slightly cloudy, light-coloured liquid, containing a minor amount of sediment with extremely low cell count and cells without atypia. Her thorax-X-ray showed elevated diaphragm domes without any cardiovascular or pulmonary irregularities. An abdomen CT showed no abnormalities, except for left ovary enlargement. Her ovarian carcinoma marker (CA125) level was high. Hence, two laparoscopies were performed, which revealed no changes in her ovaries. No tumour cells were observed in the sample from the ovary. Hence, she was referred to another hospital for evaluation of other causes of ascites. Of note, she had been receiving mycophenolic acid. In view of suspected drug etiology, the woman’s treatment with mycophenolic acid was replaced with azathioprine between September 2019 and October 2019. However, no improvement in ascites was observed. Due to the high-risk of transplant rejection, her treatment with mycophenolic acid was re-started. She had undergone left ovary oophorectomy in February 2019, and histopathological examination showed several small cysts filled with serous fluid. No tumour cells present in the peritoneal fluid or ovary. In spite of the procedure, ascites recurred, requiring cyclical decompression. After five months, her ascites spontaneously stopped growing. She had received a total of 9 paracentesis procedures. Therefore, no further paracentesis was required. Kikowicz M, et al. Massive Ascites of Unknown Origin: A Case Report. Transplantation Proceedings 52: 2527-2529, No. 8, Oct 2020. Available from: URL: http:// doi.org/10.1016/j.transproceed.2020.01.094
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Reactions 21 Nov 2020 No. 1831
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