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Gut 59:1225 doi:10.1136/gut.2009.198986
  • Editor's quiz: GI snapshot

Diarrhoea and weight loss in an immunosuppressed patient

  1. Martin Lombard1
  1. 1Department of Gastroenterology, Royal Liverpool University Hospital, Royal Liverpool & Broadgreen University Hospitals NHS Trust, Liverpool, UK
  2. 2Department of Pathology, Royal Liverpool University Hospital, Royal Liverpool & Broadgreen University Hospitals NHS Trust, Liverpool, UK
  1. Correspondence to Dr Martin Lombard, Department of Gastroenterology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK; martin.lombard{at}rlbuht.nhs.uk
  • Published Online First 14 May 2010

Clinical presentation

A 74-year-old Caucasian female presented with a 12 month history of non-bloody, culture-negative diarrhoea associated with weight loss of 10 kg. She denied any extragastrointestinal manifestations. She had previously undergone orthotopic liver transplantation for primary biliary cirrhosis 12 years ago. Her immunosuppression was mycophenolate mofetil 500 mg twice daily for the past 2 years. She had previously been on ciclosporin but this was discontinued due to renal impairment.

Baseline bloods revealed: haemoglobin 9.6 g/dl (mean corpuscular volume (MCV) 85 fl), C-reactive protein 76 mg/l and normal renal and liver biochemistry. She was euthyroid, and coeliac serology was negative. Colonoscopy demonstrated moderate, patchy mucosal inflammation predominantly affecting the proximal colon (figure 1). Multiple biopsies were obtained.

Figure 1

Ascending colon.

Questions

What is the diagnosis?

What is the best management?

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Answers

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