Makazu, MakomoTeranishi, Jun-ichiKobayashi, RyosukeOzeki, YuichiroIkeda, RyosukeSato, ChikoNishio, MasafumiMaeda, KokiMaeda, ShinInayama, YoshiakiHirasawa, KingoFukuchi, TakehideSawada, AtsushiThrombotic microangiopathy (TMA) is a serious complication following kidney transplantation. Although intestinal TMA is a major organ injury and causes abdominal pain, diarrhea and bloody stools, the clinical and endoscopic characteristics of small intestinal TMA remain unclear. Here, we report a drug-induced small intestinal TMA, which did not meet the laboratory-defined TMA criteria but was diagnosed by balloon-assisted enteroscopy (BAE). A 32-year-old woman who underwent kidney transplantation at the age of 10 years complained of abdominal pain, diarrhea and bloody stools one month after starting everolimus (EVE) as an immunosuppressant. Although she did not meet the diagnostic criteria for TMA serologically, BAE revealed a circumferential ulcer in the jejunum, and the pathological findings of a biopsy specimen showed microvascular thrombi, compatible with intestinal TMA. Her symptoms improved upon the discontinuation of EVE, demonstrating that EVE can cause drug-induced intestinal TMA. The present case suggests that BAE should be performed when abdominal pain, diarrhea, and bloody stools occur in patients receiving immunosuppressive medication following kidney transplantation, even if there is no evidence of TMA according to the laboratory definition. Keywords Thrombotic microangiopathy, balloon-assisted enteroscopy, kidney transplantation, everolimus, small intestine Ann Gastroenterol 2021; 34 (1): 119-121text/htmlapplication/pdfhttp://www.annalsgastro.gr/index.php/annalsgastro/article/view/5535engHellenic Society of GastroenterologyCopyright (c) 2021 Annals of Gastroenterology1792-74631108-7471Annals of Gastroenterology; Volume 34, No 1 (2021); 119Small intestinal thrombotic microangiopathy following kidney transplantation diagnosed by balloon-assisted enteroscopyinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion2021-01-04Δημοσίευση σε περιοδικόPublication in journalΓαστροεντερολογίαGastroenterologyisi -Gastroenterology & Hepatology covers resources on the anatomy, physiology, biochemistry, and pathology of the digestive system. This category includes specific resources on the prognosis and treatment of digestive diseases; stomach ulcers; metabolic, genetic, infectious and chemically induced diseases of the liver; colitis; diseases of the pancreas and diseases of the rectum.Επιστημονικό άρθροScientific articleΕλληνική Γαστροεντερολογική ΕταιρίαGreek Aggregator OpenArchives.gr | National Documentation Centre (EKT)other