Unusual Ileocecal Ulcers after Liver Transplantation for Hepatitis B Cirrhosis and Hepatocellular Carcinoma

Abstract

We presented a case demonstrating ileocecal ulcers after liver transplantation for hepatitis B cirrhosis and hepatocellular carcinoma. The patient presented 4 years post-transplant with paroxysmal right lower abdominal pain. Due to a mild increase in the leukocyte and neutrophil count, infectious diseases were initially suspected. However, probiotic treatment did not help improve the symptom. An enhanced CT scan revealed a thickening in the ileocecal region, and endoscopy later showed multiple giant and deep ulcers in the ileocecal region with polypoid hyperplasia. Histopathology of an ulcer biopsy displayed benign ulcers, and chronic inflammation with non-caseous granulomas, without signs of a fungus or parasite infection. Epithelial exfoliation with atypical hyperplasia was observed, and a tacrolimus-induced ileocecal ulcer was considered by a pathologist. Clinical manifestation, lab findings, radiology, and pathology characteristics of ulcers were not consistent with the pathogenesis of ischemia, tuberculosis, CMV, EBV, tumor, or inflammatory bowel diseases. Abdominal pain was gradually relieved and subsided with the discontinuation of tacrolimus and corticosteroid administration.

Keywords

• liver transplantation
• ileocecal ulcer
• tacrolimus