[Palpebral ptosis, a rare ocular manifestation of Crohn's disease]. / Ptosis palpebral: manifestación ocular inusual de la enfermedad de Crohn.

CLINICAL CASE: An 18 year-old-woman presented with abdominal pain, diarrhea, and ptosis in her left eye. Nuclear magnetic resonance imaging (NMRI) and the study of cerebrospinal fluid detected no abnormalities. Colonoscopy revealed a Crohn's disease (CD) confirmed by histological examination of biopsies. Ocular symptoms improved after appropriate treatment of the underlying CD. DISCUSSION: Inflammatory bowel disease (IBD) is associated with a wide variety of extra-intestinal manifestations, in fact it may be considered a systemic disorder with predominantly gastrointestinal tract manifestations. Extra-intestinal manifestations of inflammatory bowel disease (IBD) occur in one third of patients. Ocular complications are infrequent, occurring in less than 10% of cases, but can be associated with significant morbidity, including blindness. Ocular symptoms may precede a diagnosis of IBD. We report the first case of palpebral ptosis associated with Crohn's disease.

Efficacy and safety of monotherapy with mycophenolate mofetil in liver transplantation.

AIM: To analyze the efficacy and safety of mycophenolate mofetil (MMF) as monotherapy in liver transplant patients who have adverse effects associated with calcineurin inhibitors (CNIs). PATIENTS AND METHODS: Seventeen patients, 13 men and four women, mean age 62 years, who received a liver transplant between 1998 and 2003 and initial immunosuppressive therapy with CNIs (10 tacrolimus and seven cyclosporine), were converted to monotherapy with MMF due to adverse events associated with CNIs: chronic renal failure in 16 patients (four with diabetes mellitus and seven with hypertension) and neurotoxicity in one patient. The mean time between transplant and starting monotherapy was 32 months (range: 18 to 70) and the mean follow-up time on monotherapy was 20 months (range: 8 to 39). MMF was introduced gradually at the same time as the CNIs were reduced. RESULTS: There was a progressive decrease in creatinine during the initial months. Compared with baseline levels, the differences at 3 and 6 months of monotherapy were significant (P < .001), remaining so throughout the follow-up period. Renal function improved in 15 of 17 patients (88%) and normalized in 10 of 17 (60%). The patient with neurotoxicity due to CNI improved. One patient (6%) had moderate rejection that was corrected after reintroducing tacrolimus. In two patients it was necessary to suspend MMF, one due to gastrointestinal intolerance and the other due to severe myelotoxicity and Pneumocystis jiroveci infection. Other, minor adverse events were corrected by adjusting the dose: one herpes zoster, two diarrhea, and two anemia. CONCLUSIONS: Monotherapy with MMF efficiently and safely corrected renal dysfunction associated with CNIs, with few side effects and a low incidence of rejection.