Unusual Cause of Small Intestinal Bleeding in a Renal Transplant Recipient

Question: A 63-year-old man was admitted to our hospital because of hematochezia for days. He underwent renal transplantation 1 year before admission, with immunosuppressant mycophenolate mofetil (MMF) 360 mg bid. Upper endoscopy and colonoscopy revealed several ulcers in the terminal ileum (Figure A). The patient had persistent intermittent bleeding with required daily blood transfusion. A capsule endoscopy revealed active bleeding in the middle ileum (Figure B, Video 1). The bleeding persisted despite supportive medical therapy.

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