Table 1. Illustrates reported cases of mycophenolate-induced colitis to date with different management strategies that have been used; the table also indicates the timing of symptom improvement from the intervention.

Important to note that all patients underwent colonoscopy and/or flexible sigmoidoscopy for tissue pathology.

	Mycophenolate mofetil (MMF) dosing	Main symptom	Endoscopic findings	Histologic findings	Steroids given? (dosing)	Infliximab Given? (dosing)	Timing of symptom improvement
Bouhbouh (2010)	500mg BID	Watery, non-bloody diarrhea, abdominal pain, weight loss	Linear ulcerations throughout colon	Extensive ulceration with transmural mixed-cellular infiltration without granulomata	Yes.  2 weeks of Prednisone 30 mg PO daily, followed by 2 weeks of 25 mg prednisolone IV BID	Yes (5mg/kg)	72 hours after Infliximab
Johal (2014)	1,500 mg BID	Watery, non-bloody diarrhea, abdominal pain, weight loss	Segmental erythematous mucosa with ulcers in sigmoid, descending, splenic flexure and proximal transverse colon	Dilated crypts, eosinophilic epithelial changes, crypt abscesses with apoptotic bodies	No	No	5 weeks following MMF cessation
Goyal (2016)	Not provided	Watery, non-bloody diarrhea, abdominal tenderness and distention	Normal mucosa	Crypt atrophy, increased crypt apoptosis	No	No	3 days following MMF cessation
Jakes (2012)	750 mg bid	Abdominal pain and weight loss	Patchy inflammation of ascending colon, ileocecal valve was grossly thickened, stenosed, and ulcerated, consistent with a Crohn’s-like disease process.	Extensive ulceration	No	No	8 weeks following MMF reduction first to 250 mg bid and eventually discontinuing.  Pt also underwent ex-lap s/p right hemicolectomy with no evidence of inflammatory changes within small or large bowel
Jakes (2012)	750 mg bid	Watery, non bloody diarrhea with large mucus	Severe pancolitis	Noncaseating granulomas within the lamina propria consistent with Crohns Disease	No	No	Resolution of colitis after MMF cessation, duration unknown
Jakes (2012)	180 mg bid	Profuse watery, non bloody diarrhea with right lower quadrant abdominal tenderness	Pancolitis with rectal sparing	Focal active colitis, no granulomas.	No	No	8 months after discontinuation of Myfortic, patient had sigmoidoscopy which showed no active inflammation.  Unknown when patient noted improvement in symptoms
Moroncini (2018)	Not provided but started 2 months ago	Left sided abdominal pain, nausea, vomiting, and fever	Mucosal hyperemia, multiple serpiginous ulcers involving the transverse and descending colonic mucosa, with rectal sparing	ulceration, granulation tissue and hyalinised appearance of the mucosa and submucosa	No	No	5 days following MMF discontinuation.  Repeat colonoscopy 1 month later showed complete resolution of ulcer
Tayyem (2018)	500 mg bid and Prednisone 15 mg daily	non-bloody diarrhea, dysphagia to solid food, nausea and unintentional weight loss of 2 weeks’ duration.	EGD: normal oesophagus, multiple small antral ulcers and reactive gastropathy. Colonoscopy: mucosal edema and erythema with small mucosal hemorrhages and punctate ulcerations in the ascending colon, patchy colitis in the transverse colon and rectal sparing	Colonic biopsies showed focal crypt abscesses (withered crypts) with occasional apoptosis of epithelial cells, frequent tingible body macrophages and eosinophils within the lamina propria	Patient was already on Prednisone 15 mg daily	No	5 weeks after MMF discontinuation
Gorospe (2012)	1000 mg bid	2-week history of profuse, watery diarrhoea that persisted through the night and with fasting	Flexible sigmoidoscopy showed mild erythema	apoptosis, crypt distortion and abscess; consistent with MMF-induced colitis	No	No	Five days later, the patient’s stool frequency decreased to twice daily until complete resolution. At 1 month follow-up, her MMF was restarted at a lower dose (500 mg/day) which was tolerated well without any recurrence of gastrointestinal issues.
Hamouda (2012)	Prednisone and MMF.  Dosages not known	Profuse watery diarrhea, 6 to 8 times per day and weight loss	ulcerative diffuse colitis from the cecum to the rectum	mild crypt architectural distortion (Figure 1). The lamina propria showed edema and an increased number of inflammatory cells containing many neutrophils. Damaged crypts with mucus depletion and cryptitis.  No granuloma	No	No	Symptoms regressed within 5 days after switching from MMF to azathioprine.  Control colonoscopy showed reparative changes after 2 months
Kim (2000)	Dose not known but between 2 to 3 gm daily.	abdominal pain and watery diarrhea which progressed to bloody diarrhea	multiple ulcers and mucosal hyperemia and edema in the entire colon	Histology did not reveal viral cytopathic changes and immunohistochemical stains for cytomegalovirus infection were negative.	Patient was already on steroids	No	Abdominal pain and hematochezia improved rapidly. Follow-up colonoscopy 1 month later showed complete healing of previous lesions
Johal (2014)	1000 mg bid and increased to 1500 mg bid four months prior to presentation	Abdominal pain, nausea, intermittent bloating and profuse watery non bloody diarrhea.	segmental erythematous mucosa and multiple ulcers in the sigmoid colon, descending colon, splenic flexure and proximal transverse colon	dilated damaged crypts, eosinophilic epithelial changes and crypt abscesses with apoptotic bodies, a pattern of injury highly suggestive of MMF-related colitis	No	No	5 weeks after MMF discontinuation
Sonoda (2017)	1gm daily	Watery diarrhea which progressed to bloody diarrhea	multiple deep ulcers in the ileum	mild crypt distortion	No	No	Symptoms improved soon after MMF was discontinued.  Six months later, the ileal mucosa was healed
­(Patra) 2012	Not provided	Significant weight loss, sitophobia for five months, and a recent onset of bleeding per rectum	Colonoscopy demonstrated ileal and cecal ulcers	Histopathology revealed crypt dropout, with focal disarray of the crypt architecture, along with apoptosis of the crypt epithelial cells. The crypt epithelial apoptotic rate was greater than 5 / 100 crypts. The lamina propria was edematous and showed focal collection of mild lymphomononuclear inflammatory cell infiltrate	Patient already on steroids, unknown dose	No	1 week after MMF cessation.  Repeat colonoscopy after 1 month showed healing ulcers