P76 | Diarrhea in lung transplant recipient

M. Gino, S. Morra Di Cella, M. Gallucci, F. Bonazza, L. Gentile | Medicina Interna 1, Molinette, Torino, Italy

Premises: Diarrhoea is defined as reduced stool consistency, increased water content and number of evacuations per day. The causes of diarrhoea can be multiple: many different infectious agents, drugs, inflammatory diseases, autoimmune diseases.
Description of the Case report: A 62-year-old man has been hospitalized for diarrhea for three weeks: 6-7 discharges of watery diarrhea per day. He reports loss of appetite, reduced water intake and weight loss. In the patient’s medical history, he received a lung transplant for idiopathic pulmonary fibrosis 3 years ago. The patient’s immunosuppressive therapy was mycophenolate and tacrolimus, and he was on prophylaxis with cotrimoxazole and azithromycin. Blood tests showed acute renal failure with mild hypokalemia, negative inflammation indices. He was evaluated for bacteria, viruses, and parasites with negative results. There was a rapid normalization of renal function with hydration therapy, but persistence of diarrhea. The screening for celiac disease was negative, and thyroid function was normal. The colonoscopy was normal. In the suspicion of microscopic colitis, therapy with budesonide was started with resolution of the diarrhea. Histological examination confirmed the suspicion of microscopic colitis.
Conclusions: To solve the clinical case, we proceeded step by step. Infections were excluded and we believed that it could be a microscopic colitis and we started therapy with budesonide with an excellent clinical response. We asked if there was an association between idiopathic pulmonary fibrosis and microscopic colitis.