Korean J Transplant.  2023 Nov;37(Suppl 1):S214. 10.4285/ATW2023.F-8049.

A case of intestinal Behcet’s disease after kidney transplantation

• Shin HS
• Park M
• Kim SM
• Kim Jh
• Cho H
• Kwon SK
• Kim HY

• KMID: 2551834
• DOI: http://doi.org/10.4285/ATW2023.F-8049

Abstract

Behcet’s disease is a multisystemic, inflammatory disease with a chronic relapsing course. Intestinal Behcet’s disease is characterized by intestinal symptoms and typical colon ulcerations observed by endoscopic examination. Here, we report a case of incidental intestinal Behcet’s disease occurring 3 years after kidney transplantation. The 28-year-old male visited the emergency center presenting with recurrent abdominal pain, diarrhea, weight loss and hematochezia which occurred from 2 months ago. Oral and genital ulcers or skin lesions were absent. The patient received deceased donor kidney transplantation 3 years ago due to end-stage kidney disease of unknown origin. Two years ago, approximately 10 months after transplantation, the patient presented with abdominal pain and diarrhea and was diagnosed with cytomegalovirus (CMV) enteritis despite prophylactic ganciclovir treatment. The patient was currently on maintenance immunosuppressive therapy comprised of prednisolone, advagraf, and bredinin. The patient was acute-ill looking and anorexic and the abdomen was soft, flat, and nontender on physical examination. Laboratory examination showed following results: white blood cell 8,460/microL, hemoglobin 12.9 g/dL, blood urea nitrogen 8.6 mg/dL, serum creatinine 0.9 mg/dL, and tacrolimus therapeutic drug monitoring 4.5 ng/mL. Neither CMV antigenemia nor CMV polymerase chain reaction was present. Colonofiberscopy demonstrated an ulcer at the terminal ileum, and healing scars around the ileocecal valve. Biopsy results showed chronic active inflammation with mild gland architectural distortion, mild cryptitis, and erosions, indicative of intestinal Behcet’s disease and was prescribed mesalazine, colchicine, and mercaptopurine. His symptoms improved with intermittent mild flares during the follow-up period. Two years after diagnosis, follow-up colonoscopy also revealed similar ulcers compatible with intestinal Behcet’s disease. The patients under immunosuppression after kidney transplantation can develop intestinal Behcet’s disease. Therefore, Behcet’s disease needs to be included in the differential diagnosis of abdominal pain even in immunocompromised patients.