Paradox inflammatory reaction such as appendicitis epiploica and diverticulitis of the sigmoid colon under ongoing immunosuppression after previous liver transplantation (LTx)

Abstract Objective Inflammatory reactions caused by immunosuppression appear a particular interesting disease due to its very specific and partly unclear etiopathogenesis. Based on clinical case-specific management experiences selective references from the literature, rare case of an acute intraabdominal inflammation as unusual complication or side effect (at gastrointestinal [GI] tract) ongoing immunosuppressive medication using Mycophenolate mofetil Tacrolimus after previous liver transplantation is be illustrated. Case presentation Medical history ( hx ): 1) Current : A 68-years old male patient underwent abdominal CT scan because pain in left lower abdomen with suspicious diagnosis diverticulitis leading initiation antibiotic therapy 24 h prior transferral own hospital for adequate (LTx) follow-up investigation. 2) Medication contained Sitagliptin 1 × 100 mg, Omeprazol 40 Mesalazin 500 mg 3 2, Movicol (on demand), 2 Hydrochlorothiazid 2.5 mg. 3) Additional diagnoses included arterial hypertension, diabetes mellitus urinary bladder diverticle. 4) Previous surgical intervention profile comprises resection segments IV/V HCC (2011), orthotopic alcohol-induced cirrhosis (2013) intervertebral disc operation (2018). Physical examination revealed marked tenderness quadrant. The wall was soft there were no defensive tension peritonism. good general condition nutritional status. He cardiopulmonarily stable oriented all qualities. Diagnostic measures showed CRP 38.0 (normal range, < 5) mg/L white blood cell count within normal range. Leading found scan, which demonstrated extended diverticulosis appendicitis epiploica immediate subperitoneal region oval fat isodense structure sigmoid colon surrounding inflammatory imbibition pronounced intestinal wall. Suspicious 1st episode uncomplicated associated epiploica. Therapeutic approach given conservative infusion therapy, analgesia well inital “n. p. o.” following oral nutrition. In addition, calculated Cefuroxime Clont initiated. Clinical course uneventful, discharge eighth day stay pathological findings substantial improvement laboratory findings. Further advice consisted control investigations family practitioner counselling. colonoscopy should performed four months. Conclusions described i) either one many effects listed “colonic inflammation” “gastrointestinal inflammation”, respectively, ii) can considered response susceptible (gastro-)intestinal mucosa whole microbes microbial particles agents transplantation-associated medication.