Böbrek Nakli Sonrası İskemik Kolit ile Prezente olan Tacrolimus İlişkili Trombotik Mikroanjiyopati: Bir Olgu Sunumu

Year 2024, Volume: 19 Issue: 1, 146 - 150, 28.03.2024

Cihan Uysal , Hanife Oğuz Burcu Bozkurt Burgucu , Kemal Deniz , İsmail Koçyiğit

https://doi.org/10.17517/ksutfd.1211440

Abstract

Kalsinörin inhibitörleri (KNİ), böbrek transplantasyonu sonrası immünosupresif rejimin önemli bir üyesidir. KNİ'ler bazı sitokinlerin gen transkripsiyonunu inhibe ederek, T hücre aktivasyonunu baskılar. Böbrek transplantasyonu yapılan hastaların çoğunda takrolimus tercih edilmektedir. Trombotik mikroanjiyopati (TMA), KNİ tedavisinin ciddi fakat nadir görülen bir komplikasyonudur. TMA, mikrovasküler tromboza yol açan arteriyollerin ve kapillerlerin spesifik bir patolojik lezyonunu tanımlar. Olgumuz, 45 yaşında erkek hasta olup otozomal dominant polikistik böbrek hastalığı (ODPKBH) nedeniyle beş ay önce böbrek transplantasyonu olmuştur. İdame immünosüpresif tedavisi takrolimus içermektedir. Nakil sonrası beşinci ayda karın ağrısı ve kanlı ishal şikayeti oluşmuş. Yapılan kolonoskopide çıkan kolonun mukozası ödematöz ve eritematöz olarak saptandı. Biyopsi örneklerinin incelemesinde lamina propriyadaki damar lümeni içindeki mikrotrombüs odakları gösterildi. Abdominal bilgisayarlı tomografi (BT) anjiyografi ile vasküler tromboz veya tıkanıklık araştırılıp dışlanmıştır. Bakılan periferik yaymada, şistositler ve ılımlı derecede trombositopeni izlenildi. Klinik, laboratuvar ve histolojik bulgular ışığında TMA tanısı konuldu. Takrolimus patolojik sürecin tetikleyicisi olarak değerlendirildi, hızlıca everolimus ile değiştirildi. Daha sonra laboratuvar anormallikleri ve klinik semptomlar düzeldi. Biz bu olgu sunumunda; ilaca bağlı TMA ve kolonun mikrovasküler gibi atipik tutulum lokalizasyonuna dikkat çekmeyi amaçladık.

Keywords

böbrek nakli, iskemik kolit, takrolimus, trombotik mikroanjiyopati

Tacrolimus-Associated Thrombotic Microangiopathy Presenting with Ischemic Colitis After Kidney Transplantation: A Case Report

Abstract

Calcineurin inhibitors (CNIs) are a significant component of the immunosuppressive regimen after kidney transplantation. By inhibiting cytokine gene transcription, CNIs suppress T cell and T cell-dependent B cell activation. Tacrolimus is preferred in most patients undergoing kidney transplantation. Thrombotic microangiopathy (TMA) is a severe but rare complication of CNIs therapy. TMA defines a specific pathologic lesion of arterioles and capillaries that leads to microvascular thrombosis. A 45-year-old male underwent kidney transplantation five months ago due to autosomal dominant polycystic kidney disease (ADPKD). His triple-maintenance immunosuppressive therapy includes tacrolimus. Abdominal pain and bloody diarrhea occurred in the fifth month of posttransplant. The edematous and erythematous mucosa of the ascending colon was detected on the colonoscopy. The foci of microthrombi inside the vessel lumen in the lamina propria were shown biopsy. The thrombosis or occlusion was excluded with computerized tomography (CT) angiography in abdominal vessels. The fragmented red blood cells and moderate thrombocytopenia were detected on the peripheral blood smear. Eventually, TMA diagnosis was established through laboratory and histological findings. Tacrolimus was suspected as the trigger of the pathological process and promptly switched to the everolimus. Afterward, laboratory abnormalities and clinical symptoms were improved. In this case, we intend to emphasize drug-associated TMA and atypical presentations, such as colonic microvasculature involvement.

Keywords

kidney transplantation, tacrolimus, thrombotic microangiopathy, ischemic colitis

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