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03 May 2018 : Case report  Saudi Arabia

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

Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Adverse events of drug therapy , Congenital defects / diseases, Educational Purpose (only if useful for a systematic review or synthesis)

Musaed Mohammed Alsebayel1ABCEF*, Faisal Abdulrahman Abaalkhail23ADE, Faisal Mohammed Alsebayel1BE, Dema A. Alissa4BDE, Ahmed Hamdan Al-Jedai34BDE, Hussien Elsiesy23ADEF

DOI: 10.12659/AJCR.908433

Am J Case Rep 2018; 19:523-526

Abstract

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.

Keywords: Congenital Abnormalities, esophageal atresia, Teratogens

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923