Abstract：
A 46-year-old man with myelodysplastic syndrome/myeloproliferative neoplasm-unclassifiable underwent myeloablative bone marrow transplantation from an HLA-DR-1-antigen-mismatched related donor while receiving tacrolimus and mycophenolate mofetil (MMF) for graft-versus-host disease (GVHD) prophylaxis. However, grade III acute GVHD of the gut occurred on day 20 and was treated with prednisolone (PSL) and oral beclomethasone dipropionate while continuing MMF. Subsequently, he presented with progressive epigastric pain. Endoscopy demonstrated multiple stomach and duodenal deep ulcers. The ulcers were suspected to be GVHD; thus, the PSL dose was increased and infliximab was administered; however, the ulcers exacerbated, resulting in repeated perforations and hemorrhagic shock. Furthemore, MMF was suspected as the cause of refractory ulcers and was discontinued on day 156, which resolved the ulcers after 6 months. MMF-induced gastrointestinal (GI) injury resembles anti-inflammatory drug-related ulcers and upper and lower GI tract GVHD, respectively. MMF-induced GI injury has been reportedly resolved after discontinuing or reducing the MMF dose. Several reports suggested that refractory upper GI ulcers and rectal sparing colitis were associated with MMF toxicities rather than GVHD in hematopoietic stem cell transplantations. Physicians should be aware that MMF can induce severe GI injury.
摘要：
一名46岁的骨髓增生异常综合征/骨髓增殖性肿瘤无法分类的男子接受了HLA-DR-1抗原不匹配的相关供体的清髓性骨髓移植，同时接受他克莫司和霉酚酸酯（MMF）用于移植物抗宿主病（GVHD）预防。然而,肠道III级急性GVHD发生在第20天,并在继续MMF的同时接受泼尼松龙(PSL)和口服二丙酸倍氯米松治疗.随后，他表现为进行性上腹痛。内窥镜检查显示多发性胃和十二指肠深部溃疡。溃疡被怀疑是GVHD；因此，增加PSL剂量并给予英夫利昔单抗;然而,溃疡加剧了，导致反复穿孔和失血性休克。更重要的是，怀疑MMF是难治性溃疡的原因，并在第156天停药，6个月后治愈了溃疡。MMF引起的胃肠道（GI）损伤类似于抗炎药相关的溃疡和上消化道和下消化道GVHD，分别。据报道,MMF诱导的GI损伤在中断或减少MMF剂量后得到解决。一些报告表明，在造血干细胞移植中，难治性上消化道溃疡和直肠保留性结肠炎与MMF毒性而不是GVHD相关。医生应该意识到MMF会导致严重的胃肠道损伤。
