Tacrolimus-Induced Acute Esophageal Necrosis.

Acute esophageal necrosis (AEN) has been rarely described and has poorly understood pathophysiology although it is thought to be related to mucosal defense barrier disruption. We report a case of AEN in a 71-year-old patient with clinical signs of gastric outlet obstruction along with anemia and sepsis in the setting of a recent kidney transplant. After failing standard supportive measures, tacrolimus was switched to cyclosporin with overall rapid improvement of AEN and concomitant duodenal ulcerations. This case underscores a possible rare adverse effect of a commonly used immunosuppressant agent that, to our knowledge, has not been specifically reported.

Seronegative Adult Autoimmune Enteropathy in a Patient With Rheumatoid Arthritis.

Autoimmune enteropathy is a rare disorder of the immune system. We present a 75-year-old woman with rheumatoid arthritis who presented with 4 months of intractable vomiting, diarrhea, and unexplained weight loss. Initial workup was negative for infection and celiac disease, but her symptoms progressed. Repeat esophagogastroduodenoscopy showed duodenal scalloping and friability. Biopsies of the duodenum and terminal ileum showed glandular destruction, epithelial apoptosis, and goblet cell depletion. Colonoscopic examination was normal, and random colon biopsies did not show evidence of microscopic colitis. She was diagnosed with autoimmune enteropathy, and treatment consisted of an extended corticosteroid taper, with the resolution of symptoms.