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A rare cause of abdominal pain, diarrhoea and GI bleeding
  1. Faidon-Marios Laskaratos1,
  2. Mark Hamilton1,
  3. Marco Novelli2,
  4. Neil Shepherd3,
  5. Gareth Jones4,
  6. Christopher Lawrence5,
  7. Miriam Mitchison6,
  8. Charles D Murray1
  1. 1Centre for Gastroenterology, Royal Free Hospital NHS Foundation Trust, London, UK
  2. 2Department of Histopathology, University College Hospitals NHS Foundation Trust, London, UK
  3. 3Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Sandford Road, Cheltenham, Glos, UK
  4. 4Centre for Nephrology, Royal Free Hospital NHS Foundation Trust, London, UK
  5. 5Department of Nephrology, East and North Hertfordshire NHS Trust, Hertfordshire, UK
  6. 6Department of Histopathology, East and North Hertfordshire NHS Trust, Hertfordshire, UK
  1. Correspondence to Dr Charles D Murray, Centre for Gastroenterology, Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London NW3 2QG, UK; charlesmurray1{at}nhs.net

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A 62-year-old woman presented with abdominal pain and diarrhoea. She had a history of primary biliary cirrhosis and renal transplantation secondary to reflux nephropathy. Cross-sectional imaging and a colonoscopy demonstrated terminal ileal inflammation and ulceration, but histological biopsies were inconclusive and cytomegalovirus staining was negative. The patient subsequently developed spontaneous small bowel perforation due to deep ulceration, necessitating an emergency right hemicolectomy. Her postoperative period was complicated by several episodes of rectal bleeding. After a prolonged admission at her local hospital, the patient was referred to our unit for further management.

On arrival, the patient's immunosuppression consisted of tacrolimus and low-dose prednisolone. Mycophenolate mofetil …

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