Abstract: Reported herein are two rare complications occurring in a liver transplant recipient: Colonic malakoplakia and therapy (azathioprine)-related myelodysplastic syndrome (Rx-MDS) with complex cytogenetic abnormalities. The patient, a 65-year-old male, received a liver transplant in April 2012, followed by 16 months of maintenance azathioprine/prednisone. In December 2014, he presented with severe chronic diarrhea and unexplained refractory pancytopenia. Two months earlier, his marrow was normocellular and devoid of dysplasia, although chromosomal analysis at this juncture disclosed complex cryptogenic defects, with abnormal chromosome 7. Colonic malakoplakia was evident by colonoscopy. Both CBC and diarrhea resolved upon azathioprine withdrawal, steroid dose adjustment, antibiotic administration (ciprofloxacin, 20 days), and other supportive measures. Chronic diarrhea is common in liver transplant recipients who develop Colonic malakoplakia. Immunotherapeutic intervention (plus antibiotic and cholinergic treatment) is effective and is potentially curative. Azathioprine heightens the risk of developing Rx-MDS, which likewise may remit upon withdrawal.
Keywords: Colonic malakoplakia, liver transplant, azathioprine-related myelodysplastic syndrome, cytogenetic abnormalities.
Title: Colonic Malakoplakia and Therapy-related Myelodysplastic Syndrome in Liver Transplant Recipient: Case Report and Review
Author: Bader Alshamsan
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
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