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Abstract: FR-PO788

Eosinophilic Gastroenteritis due to Belatacept: Novel Side Effect of a Novel Agent

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Batool, Aisha, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Veitla, Vineet, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Saad, Ehab R., Medical College of Wisconsin, Milwaukee, Wisconsin, United States

Belatacept is a novel fusion protein composed of the Fc fragment of human IgG1 linked to the extracellular domain of cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4), selectively inhibits T-cell activation through costimulation blockade. Eosinophilic Gastrointestinal Disease (EGID) is a rare disorder characterized by focal or diffuse eosinophilic infiltration of the bowel wall with various gastrointestinal manifestations.

Case Description

Our Patient is a 24-year-old Caucasian Male with ESRD s/p LRKT 10 years ago. The patient was induced with Simulect(Basiliximab), thereafter he was started on immunosuppression regimen with Belatacept 750mg intravenous injection, Cellcept 750mg twice daily and tapering doses of Prednisone and has had a smooth post transplant course. About two years after the transplant, he started complaining of epigastric pain, worse on ‘’bending forward’. Laboratory data revealed peripheral eosinophilia 9% and iron deficiency anemia. Endoscopy revealed mucosal edema with extensive ulcerations and nodularity of esophagus, duodenum, and terminal ileum. Histopathology revealed extensive ulcerations of esophagus, duodenum, and terminal ileum with diffuse eosinophilic infiltration. Belatacept was stopped resulting in complete resolution of clinical symptoms, peripheral eosinophilia,Anemia and also complete resolution of the esophageal and duodenal ulcerations with resolution of eosinophilic infiltration.


Drug induced EGIDs are very rare and there are only few case reports of drug induced EGIDs. Diagnosis is usually lead by High index of suspicion paired with exclusion of other causes of peripheral eosinophilia. Final diagnosis is made with biopsy proven eosinophilic infiltration of bowel wall. T cell co-stimulation through CD28 and B7–2 plays an important role in allergic responses and administration of a CTLA-4 immunoglobulin blocks this interaction. Thus, we may surmise that costimulation blockade with Belatacept could trigger allergic conditions such as EGIDs.