Ozempic, Travel, and Troublesome Diarrhoea: Lessons from a Transplant Case

Suggested Citation Isleyici, T. K. (2025). Ozempic, Travel, and Troublesome Diarrhoea: Lessons from a Transplant Case. European Emergency Medicine Congress (EUSEM 2025), Vienna, Austria.https://doi.org/10.5281/zenodo.19409788 Introduction and Purpose: Diagnosing and managing acute gastrointestinal symptoms in renal transplant recipients requires a high index of suspicion, as underlying immunosuppression and complex medication regimens can mask symptoms or accelerate complications. We present a case of severe infectious traveller's diarrhoea leading to acute kidney injury (AKI) in a transplant patient, initially confounded by a recent history of semaglutide (Ozempic) induced diarrhoea. Materials and Methods: A 54-year-old male, normally residing in Germany, presented to the emergency department in southern Turkey with profuse watery diarrhoea (up to 10 episodes/day). He underwent a renal transplantation in 2008 secondary to hypertensive nephropathy and NSAID overuse. His medication regimen included methylprednisolone, ciclosporin, mycophenolic acid, and several cardiovascular drugs. Notably, he had a recent history of prolonged diarrhoea attributed to semaglutide use, which had resolved upon cessation. On presentation, he was tachycardic (123 bpm) but normotensive and afebrile. Laboratory investigations revealed pre-renal acute kidney injury with a blood urea nitrogen of 68.10 mg/dL and creatinine of 2.62 mg/dL. Full blood count showed neutrophilic leukocytosis, and stool microscopy revealed abundant leukocytes, confirming an infectious aetiology rather than a recurrence of medication-induced adverse effects. Following an urgent nephrology consultation, mycophenolic acid and torasemide were temporarily withheld, and targeted antibiotic therapy (ciprofloxacin and ornidazole) was initiated. Results and Conclusion: This case highlights the critical importance of early specialist input, meticulous medication review, and vigilance for dehydration-induced complications in immunocompromised hosts, illustrating how an otherwise self-limiting gastrointestinal infection can rapidly escalate to renal compromise. (Presented as a poster presentation at the EUSEM 2025 European Emergency Medicine Congress, Vienna, September 2025)