Journal de néphrologie et thérapeutique

Celiac Disease Secondary to Tacrolimus after Human Renal Transplantation: A Case Report

Abstract

Narjes Ben Aicha, Sahtout Wissal, Azzabi Awatef, Mrabet Sanda, Toumi Salma, Guedri Yosra, Zallema Dorsaf and Achour Abdellatif

Celiac disease is an autoimmune disorder affecting primarily the small intestine. Although rare celiac disease is a possible cause of diarrhea after renal transplantation. Our case is the first to report that tacrolimus could be cause of celiac disease after renal transplantation. A woman aged 34 years old, with a renal transplantation from a cadaveric donor. For maintenance therapy, she underwent tri-therapy with Tacrolimus. She was complaining from chronic diarrhea with weight loss unimproved at 16 months after the TR and despite the switch from Mycophenolate mofetil to Azathioprine. She had an anemia and signs of malabsorption with a congestive duodenitis in the gastroscopy and villous atrophy in moderate area in the biopsy. Celiac serology was positive. The patient underwent gluten-free diet during 6 months without improvement. Tacrolimus was stopped and switched to Cyclosporine A. After this attitude the diarrhea disappeared and we note a weight gain and improvement of biological parameters. Control of antibodies after conversion to cyclosporine A was negative. Celiac disease is rare in the transplant recipient and never confirmed with immunogical test. There was no case in the literature that reported tacrolimus as cause of celiac disease. Our case is the first witch reported celiac disease after transplantation and confirmed with an immunological test and it was caused by tacrolimus.