SHM Converge Scientific Abstract ePoster Gallery-Deceptive Case of De Novo Crohn's in Heart Transplant Patient

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This case report describes a rare instance of de novo inflammatory bowel disease (IBD) in a heart transplant patient. A 62-year-old man with a history of type 2 diabetes, hypertension, hypercholesterolemia, mild COPD, chronic diarrhea, and a heart transplant nine years earlier presented with repeated hospitalizations for worsening diarrhea that had begun after his transplant. His symptoms included increased stool frequency, urgency, fecal incontinence, intermittent melena, and fevers.<br /><br />Diagnosing the cause of his colitis was difficult because several factors could explain his symptoms, including his transplant status, use of mycophenolate mofetil (MMF), and persistent Clostridioides difficile infection that partially improved with fidaxomicin. In heart transplant patients, diarrhea is common and can increase morbidity and mortality, but IBD is rarely reported, especially Crohn’s disease, making it a low initial suspicion.<br /><br />Repeat colonoscopy showed multiple rectal ulcerations suggestive of inflammatory bowel disease, and biopsy confirmed Crohn’s disease. The patient’s symptoms ultimately resolved with infliximab treatment.<br /><br />The report highlights how multiple confounders can complicate the evaluation of chronic diarrhea and colitis in transplant recipients. It emphasizes that clinicians should maintain a lower threshold for considering IBD in heart transplant patients with persistent diarrhea, even though it is uncommon and may be masked by other plausible causes such as infection or medication effects.

Asset Subtitle

Leeann Hu

Meta Tag

Author List Amar Mandalia, Cynthia Schwartz, Emmanuel Magsino, Jorge Restrepo, Leeann Hu

Category Clinical Vignettes

Concept Inflammatory Bowel Disease

Concept Crohn Disease

Concept Chronic Diarrhea

Concept Biopsy

Concept Differential Diagnosis

Distinguished Non-Finalist

Presenter Organization Naval Medical Center Portsmouth

Presenting Author Leeann Hu

Track Adult

Keywords

heart transplant

inflammatory bowel disease

Crohn's disease

chronic diarrhea

mycophenolate mofetil

Clostridioides difficile

colitis

colonoscopy

infliximab

transplant recipient

Inflammatory Bowel Disease

Crohn Disease

Chronic Diarrhea

Biopsy

Differential Diagnosis