Rapid resolution of persistent mycophenolate mofetil-induced diarrhoea with a single dose of infliximab.

Diarrhoea is a common complication seen in renal transplant recipients. Post-transplantation diarrhoea may result from infectious agents, drug-specific effects or metabolic conditions. Although infections are the major cause of diarrhoea after transplantation, almost a quarter of the cases are related to medication. Approximately 50% of the drug-induced diarrhoea is caused by mycophenolate mofetil (MMF) [1]. MMF is a commonly used immunosuppressive agent that can induce ulcerating colitis [2,3]. MMF-induced ulcerating colitis is a diagnosis by exclusion. The pathological diagnosis is difficult because of the similarities with other causes of diarrhoea such as inflammatory bowel disease [4]. Although MMF-induced colitis usually resolves after dose reduction or cessation of MMF, persistent cases have been reported [5]. We present a case in which MMF-induced ulcerating colitis persisted after withdrawal of MMF but was successfully treated with tumour necrosis factor-alpha (TNF-α) inhibition.