Mycophenolate Adverse Effect Masquerading as Extensive Pneumatosis Intestinalis (PI) after Lung Transplantation

Pneumatosis Intestinalis (PI) is a rare post lung transplant complication which is characterized by the presence of gas within the wall of the small and large intestine. PI in lung transplant recipients has been previously described and is associated with disease of varying clinical trajectories. Here we describe a case of PI in a lung transplant recipient that was attributed to immunosuppression with Mycophenolate Mofetil (MMF) as evidenced by the presence of increased crypt epithelial apoptosis on biopsy of the duodenum and clinical improvement with withdrawal of the offending agent. This case demonstrates that medication adverse effects are an important differential to consider in lung transplant recipients with PI.