ABSTRACT
Nodular lymphoid hyperplasia (NLH) of the gastrointestinal tract is a rare disease usually reported in patients with congenital or acquired immunodeficiency and chronic gastrointestinal infections. However, no case of NLH in a patient receiving immunosuppressive therapy has been reported to date. We describe the case of a woman who developed chronic diarrhea related to NLH 9 years after liver transplantation. Other causes of diarrhea and NLH were excluded. Her immunosuppressive regimen consisted on mycophenolate mofetil (MMF) and tacrolimus. Reduction of MMF dose improved symptoms but led to a rising aminotransferase level. Given the risk of graft rejection, MMF at full dose was resumed and she was started on symptomatic treatment for diarrhea. The role of immunosuppressive drugs in the pathogenesis of NLH may be related to the reduction of T- and B-lymphocyte proliferation and decreasing antibody production. NLH will further develop to compensate functionally inadequate lymphoid tissue, as reported in congenital immunodeficiency states.
Subject(s)
Gastrointestinal Diseases/etiology , Gastrointestinal Diseases/pathology , Immunosuppressive Agents/administration & dosage , Liver Transplantation , Lymph Nodes/pathology , Mycophenolic Acid/analogs & derivatives , Postoperative Complications/pathology , Diarrhea/etiology , Duodenum/pathology , Female , Graft Rejection/prevention & control , Humans , Hyperplasia , Immunosuppressive Agents/adverse effects , Intestinal Mucosa/pathology , Middle Aged , Mycophenolic Acid/administration & dosage , Mycophenolic Acid/adverse effects , Tacrolimus/therapeutic useSubject(s)
Crohn Disease/complications , Deficiency Diseases/complications , Duodenitis/complications , Gastritis/complications , alpha 1-Antitrypsin Deficiency , Adolescent , Biopsy , Crohn Disease/diagnosis , Crohn Disease/pathology , Deficiency Diseases/diagnosis , Deficiency Diseases/pathology , Duodenitis/diagnosis , Duodenitis/pathology , Gastritis/diagnosis , Gastritis/pathology , Humans , Laparotomy , MaleSubject(s)
Spleen/injuries , Adult , Child , Child, Preschool , Female , Humans , Male , Retrospective Studies , Splenectomy , Splenic Rupture/surgery , Wounds, Nonpenetrating/surgery , Wounds, Nonpenetrating/therapyABSTRACT
Between 1977 and 1982, the National Center of Salmonella of the Institute Pasteur of Tunis has isolated; received and/or identified 1715 Salmonella strains. In typhoid and paratyphoid fevers group Salmonella typhi represent the predominant species with a frequency of 99.6%. In the enteric group, Salmonella wien is the most frequent (50,26%). 11 serotypes appeared in 1982, although 5 serotypes have not been met since 1977.
