Karaciğer Nakilli Olgunun İzleminde Gelişen Eozinofilik Özofajit

Eozinofilik özofajit (EÖ), sindirim sisteminin başka hiçbir yerinde olmayıp sadece özofagusun eozinofiller ile tutulumu olarak tanımlanır. Karaciğer nakli, son dönem akut veya kronik karaciğer hastalığında ve tıbbi tedavilere dirençli karaciğer hastalığı olanlarda evrensel olarak kabul edilmiş bir tedavi yöntemidir. Ayrıca karaciğer naklinin başarısı da takrolimus ve siklosporin A gibi kullanılan immunsupresif ilaçlara bağlıdır. T akrolimus kullanımı ile intestinal bariyerin bozulmasıyla mukozanın hücresel enerji üretimi bloke olmakta ve antijenlere duyarlı halde gelmektedir. Böylece eozinofilik hastalıkların oluşmasına neden olmaktadır. Yirmi iki yaşında erkek hasta polikliniğimizden karaciğer nakli nedeni ile izlenmekte olup kusma ve öğürme yakınması ile başvurdu. On altı yaşında Wilson Hastalığı tanısı ile karaciğer nakli yapılan hastamız nakil sonrası yaklaşık 6 yıllık izleminde immünsüpresif olarak yalnızca takrolimus kullanıyordu. Endoskopide özofagusda halkalaşma ve histop atolojide >15/Büyük Büyütmede (BB) eozinofil infiltrasyonu gözlenen hastamıza eozinofilik özofajit tanısı kondu. Sistemik steroid ve ardından topikal stero id kullanan olgumuzun şikayetleri geriledi ve taburcu edildi. Yaklaşık 2 yıllık izleminde nüks gözlenmedi. Biz burada karaciğer nakli nedeni ile polikliniğimizde takipli olup izleminde eozinofilik özofajit gelişen ve sonrasında kortikosteroide çok iyi yanıt veren olguyu sunmak istedik

Eosinophilic Esophagitis Occurring During Follow-up in a Patient with Liver Transplantation

Eosinophilic Esophagitis Occurring During Follow-up in a Patient with Liver Transplantation Eosinophilic esophagitis (EE) is the eosinophilic involvement of esophagus that occurs nowhere else in intestinal system. Liver transplantation is the universally accepted treatment option in end-stage acute and chronic liver disease and by liver diseases resistant to treatment. Moreover, success of the transplantation depends on immunosuppressive agents like tacrolimus and cyclosporin A. Because of the breakdown of the intestinal barrier due to tacrolimus, cellular energy production in the mucosa is blocked and it becomes sensitive to antigens. T hus, it causes eosinophilic diseases. T wenty two years old male patient with liver transplantation presented with retching and vomiting. T his patient was diagnosed with Wilson's disease and transplanted at the age of 16 and during his 6 years follow-up he only used tacrolimus as an immunosuppressive agents. Endoscopy revealed rings, histopathology showed >15 eosinophils for each area under bigger magnification and the patient was diagnosed with eosinophilic esophagitis. Patient was administered systemic steroids and topical steroids respectively. After treatment the complaints resolved and patient was discharged. During an approximately 2 years of follow-up there was no recurrence. We aimed to present this case of a 22 years old male with liver transplantation currently under outpatient follow-up presenting with eosinophilic esophagitis and responded very well to steroid treatment

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  • 1. Spergel JM. Eosinophilic esophagitis in adults and children: evidence for a food allergy component in many patients. Curr Opin Allergy Clin Immunol 2007; 7: 274-8.
  • 2. Charlton MR. How important is acute cellular rejection? Liver Transpl 2013; 19 Suppl 2: S9- 13.
  • 3. Furukawa H, Todo S. Evolution of immunosuppression in liver transplantation: contribution of cyclosporine. Transplant Proc 2004; 36: 274-84.
  • 4. Lee JH, Park HY, Choe YH, Lee SK, Lee SI. The development of eosinophilic colitis after liver transplantation in children. Pediatr Transplant 2007; 11: 518-23.
  • 5. Kapel RC, Miller JK, Torres C, Aksoy S, Lash R, Katzka DA. Eosinophilic esophagitis: a prevalent disease in the United States that affects all age groups. Gastroenterology 2008; 134: 1316-21.
  • 6. Strauman A, Hruz P. What’s new in the diagnosis and therapy of eosinophilic esophagitis? Curr Opin Gastroenterol 2009; 25: 366-71.
  • 7. Gonsalves N, Anh T, Zhang Q, Kagalwalla A, Ditto A, Hirano I. Distinct allergic predisposition of children and adults with eosinophilic esophagitis. Gastroenterology 2006; 130: A579.
  • 8. Gonsalves N, Policarpio-Nicolas M, Zhang Q, Rao MS, Hirano I. Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis. Gastrointest Endosc 2006; 64: 313-9.
  • 9. Winter HS, Madara JL, Stafford RJ, Grand RJ, Quinlan JE, Goldman H. Intraepithelial eosinophils: a new diagnostic criteria for reflux esophagitis. Gastroenterology 1982; 83: 818- 23.
  • 10. Fogg MI, Ruchelli E, Spergel JM. Polen and eosinophilic esophagitis. J Allergy Clin Immunol 2003; 112: 796-7.
  • 11. Gupte AR, Draganov PV. Eosinophilic esophagitis. World J Gastroenterol 2009; 15: 17- 24.
  • 12. Teitelbaum JE, Fox VL, Twarog FT, et al. Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate. Gastroenterology 2002; 122: 1216-25.
  • 13. Konikoff MR, Noel RJ, Blanchard C, et al. A randomized, doubleblind, placebo-controlled trial of fluticasone propionate for pediatric eosinophilic esophagitis. Gastroenterology 2006; 131: 1381-91.
  • 14. Schaafer ET, Fitzgerald JF, Molleston JP, et al. Comparison of oral prednisone and topical fluticasone in the treatment of eosinophilic esophagitis; a randomized trial in children. Clin Gastroenterol Hepatol 2008; 6: 165-73.