Intestinal microsporidiosis occurring in two renal transplant recipients treated with mycophenolate mofetil

• Published in: Transplantation Vol. 68; no. 5; pp. 699 - 701
• Main Authors: GUERARD, A, RABODONIRINA, M, COTTE, L, LIGUORY, O, PIENS, M.-A, DAOUD, S, PICOT, S, TOURAINE, J.-L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 15-09-1999
• Subjects: Adult; Animals; Biological and medical sciences; Feces - parasitology; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Intestines - parasitology; Kidney Transplantation; Male; Medical sciences; Microsporida - isolation & purification; Middle Aged; mycophenolate mofetil; Mycophenolic Acid - adverse effects; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Opportunistic Infections - chemically induced; Postoperative Complications; Protozoan Infections - chemically induced; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Human; Mofetil; Protozoa; Opportunistic infection; Protozoal disease; Mycophenolic acid; Gut; Diarrhea; Transplantation; Parasitosis; Homotransplantation; Kidney; Cnidosporidia; Infection; Case study; Chemotherapy; Treatment; Enterocytozoon bieneusi; Digestive diseases; Intestinal disease; Complication; Microsporidiosis; Immunosuppressive agent
• ISSN: 0041-1337; 1534-6080
• DOI: 10.1097/00007890-199909150-00017

Intestinal microsporidiosis is a major cause of chronic diarrhea and malabsorption in patients with human immunodeficiency virus. Its occurrence in transplant recipients has exceptionally been reported to date.
We report what we believe are the first two cases of intestinal microsporidiosis in renal transplant recipients. The patients were treated with mycophenolate mofetil.
The clinical presentation was chronic diarrhea with massive weight loss. Stool analysis revealed microsporidian spores, identified as Enterocytozoon bieneusi spores by polymerase chain reaction. The onset of this opportunistic infection in these two patients is believed to be secondary to an increase in immunosuppression after azathioprine replacement by mycophenolate mofetil. The withdrawal of mycophenolate mofetil led to clinical recovery.
The incidence of microsporidiosis will probably increase in transplant recipients treated with powerful immunosuppressants. Therefore, we recommend a systematic search for microsporidian spores in stool specimens in cases of unexplained diarrhea in these patients.