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Congenital Esophageal Atresia and Microtia in a Newborn Secondary to Mycophenolate Mofetil Exposure During Pregnancy: A Case Report and Review of the Literature

Patient: Female, 20 Final Diagnosis: Esophageal atresia Symptoms: Cough • gagging • poor feeding Medication: Mycophenolate mofetil Clinical Procedure: Esophageal repair Specialty: Transplantology OBJECTIVE: Congenital defects/diseases BACKGROUND: Mycophenolate mofetil (MMF) is one of the most common...

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Autores principales: Alsebayel, Musaed Mohammed, Abaalkhail, Faisal Abdulrahman, Alsebayel, Faisal Mohammed, Alissa, Dema A., Al-Jedai, Ahmed Hamdan, Elsiesy, Hussien
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952718/
https://www.ncbi.nlm.nih.gov/pubmed/29720579
http://dx.doi.org/10.12659/AJCR.908433
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author Alsebayel, Musaed Mohammed
Abaalkhail, Faisal Abdulrahman
Alsebayel, Faisal Mohammed
Alissa, Dema A.
Al-Jedai, Ahmed Hamdan
Elsiesy, Hussien
author_facet Alsebayel, Musaed Mohammed
Abaalkhail, Faisal Abdulrahman
Alsebayel, Faisal Mohammed
Alissa, Dema A.
Al-Jedai, Ahmed Hamdan
Elsiesy, Hussien
author_sort Alsebayel, Musaed Mohammed
collection PubMed
description Patient: Female, 20 Final Diagnosis: Esophageal atresia Symptoms: Cough • gagging • poor feeding Medication: Mycophenolate mofetil Clinical Procedure: Esophageal repair Specialty: Transplantology OBJECTIVE: Congenital defects/diseases BACKGROUND: Mycophenolate mofetil (MMF) is one of the most commonly prescribed drugs to prevent organ transplant rejection in combination with calcineurin inhibitors and steroids. It has a different toxicity profile than tacrolimus and cyclosporine. Gastrointestinal tract disturbances are the most common adverse effects. The use of MMF in pregnant women, however, holds great risk of miscarriage and fetal development defects such as external ear malformation, ocular anomalies, cleft lip and palate, and abnormality of distal limbs, heart, esophagus, and kidneys. Based on post-marketing studies, its pregnancy category was reclassified as category D by the US FDA in 2007. CASE REPORT: A 20-year-old woman received a deceased-donor liver transplant for end-stage liver disease secondary to autoimmune hepatitis. She had 3 miscarriages while on MMF. In her fourth pregnancy she was exposed to MMF in the first trimester, which was stopped by week 20 of the pregnancy. Obstetric ultrasound suggested a cephalic presentation fetus with abdominal circumference. Her pregnancy resulted in an infant with tracheoesophageal fistula, esophageal atresia, and a bilateral ear canal atresia (microtia) with normal sensorineural conduction. There were no other congenital abnormalities. Thoracoscopic ligation of fistula and thoracotomy with esophageal repair were performed and a bone-anchored hearing aid for conductive hearing loss was implanted. Here, we report a case of congenital esophageal atresia and microtia secondary to mycophenolate mofetil. CONCLUSIONS: MMF should be avoided during pregnancy. Transplanted female patients of reproductive age should receive appropriate counseling.
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spelling pubmed-59527182018-05-17 Congenital Esophageal Atresia and Microtia in a Newborn Secondary to Mycophenolate Mofetil Exposure During Pregnancy: A Case Report and Review of the Literature Alsebayel, Musaed Mohammed Abaalkhail, Faisal Abdulrahman Alsebayel, Faisal Mohammed Alissa, Dema A. Al-Jedai, Ahmed Hamdan Elsiesy, Hussien Am J Case Rep Articles Patient: Female, 20 Final Diagnosis: Esophageal atresia Symptoms: Cough • gagging • poor feeding Medication: Mycophenolate mofetil Clinical Procedure: Esophageal repair Specialty: Transplantology OBJECTIVE: Congenital defects/diseases BACKGROUND: Mycophenolate mofetil (MMF) is one of the most commonly prescribed drugs to prevent organ transplant rejection in combination with calcineurin inhibitors and steroids. It has a different toxicity profile than tacrolimus and cyclosporine. Gastrointestinal tract disturbances are the most common adverse effects. The use of MMF in pregnant women, however, holds great risk of miscarriage and fetal development defects such as external ear malformation, ocular anomalies, cleft lip and palate, and abnormality of distal limbs, heart, esophagus, and kidneys. Based on post-marketing studies, its pregnancy category was reclassified as category D by the US FDA in 2007. CASE REPORT: A 20-year-old woman received a deceased-donor liver transplant for end-stage liver disease secondary to autoimmune hepatitis. She had 3 miscarriages while on MMF. In her fourth pregnancy she was exposed to MMF in the first trimester, which was stopped by week 20 of the pregnancy. Obstetric ultrasound suggested a cephalic presentation fetus with abdominal circumference. Her pregnancy resulted in an infant with tracheoesophageal fistula, esophageal atresia, and a bilateral ear canal atresia (microtia) with normal sensorineural conduction. There were no other congenital abnormalities. Thoracoscopic ligation of fistula and thoracotomy with esophageal repair were performed and a bone-anchored hearing aid for conductive hearing loss was implanted. Here, we report a case of congenital esophageal atresia and microtia secondary to mycophenolate mofetil. CONCLUSIONS: MMF should be avoided during pregnancy. Transplanted female patients of reproductive age should receive appropriate counseling. International Scientific Literature, Inc. 2018-05-03 /pmc/articles/PMC5952718/ /pubmed/29720579 http://dx.doi.org/10.12659/AJCR.908433 Text en © Am J Case Rep, 2018 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Alsebayel, Musaed Mohammed
Abaalkhail, Faisal Abdulrahman
Alsebayel, Faisal Mohammed
Alissa, Dema A.
Al-Jedai, Ahmed Hamdan
Elsiesy, Hussien
Congenital Esophageal Atresia and Microtia in a Newborn Secondary to Mycophenolate Mofetil Exposure During Pregnancy: A Case Report and Review of the Literature
title Congenital Esophageal Atresia and Microtia in a Newborn Secondary to Mycophenolate Mofetil Exposure During Pregnancy: A Case Report and Review of the Literature
title_full Congenital Esophageal Atresia and Microtia in a Newborn Secondary to Mycophenolate Mofetil Exposure During Pregnancy: A Case Report and Review of the Literature
title_fullStr Congenital Esophageal Atresia and Microtia in a Newborn Secondary to Mycophenolate Mofetil Exposure During Pregnancy: A Case Report and Review of the Literature
title_full_unstemmed Congenital Esophageal Atresia and Microtia in a Newborn Secondary to Mycophenolate Mofetil Exposure During Pregnancy: A Case Report and Review of the Literature
title_short Congenital Esophageal Atresia and Microtia in a Newborn Secondary to Mycophenolate Mofetil Exposure During Pregnancy: A Case Report and Review of the Literature
title_sort congenital esophageal atresia and microtia in a newborn secondary to mycophenolate mofetil exposure during pregnancy: a case report and review of the literature
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952718/
https://www.ncbi.nlm.nih.gov/pubmed/29720579
http://dx.doi.org/10.12659/AJCR.908433
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