mycophenolic-acid and Oral-Ulcer

A case of mycophenolate mofetil (MMF)-induced oral ulceration in a kidney transplant recipient is reported.. A 54-year-old man who had received a kidney transplant 7 months previously reported to our outpatient clinic with severe oral ulcers with odynophagia and was admitted to the hospital. His maintenance immunosuppressive agents at the time of admission consisted of tacrolimus and mycophenolate. The patient had stable renal function, with all laboratory values within normal ranges. After various alternative etiologies were ruled out, drug-induced oral ulceration was suspected, and the patient's tacrolimus dose was empirically reduced, resulting in reduction of the trough concentration from 10 ng/mL to 3.3 ng/mL without improvement of the ulceration. Mycophenolate-induced oral ulceration was suspected, and MMF was discontinued. Within 5 days of discontinuation, there was a remarkable improvement in both the size and severity of the ulceration, and the patient was discharged from the hospital. During the next clinic visit (a total of 12 days after MMF was discontinued), the patient's mouth and esophageal ulcers had completely healed. Six weeks after complete resolution of the ulcer, MMF at a dosage of 250 mg twice daily was initiated; the dosage was subsequently increased to 500 mg twice daily without a recurrence of ulceration.. A 54-year-old man developed oral ulceration after 7 months of MMF therapy. Discontinuation of therapy resulted in prompt resolution of the patient's ulcers, with no recurrence of ulceration at a lower MMF dose. This is the first case report indicating that mycophenolate-induced ulceration may be dose dependent.

Topics: Dose-Response Relationship, Drug; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Mycophenolic Acid; Oral Ulcer; Tacrolimus

Frosted branch angiitis is a rare, severe condition. It can be either a primary or a secondary condition and is characterized by rapid deterioration of vision and fulminant retinal vasculitis that manifests as diffuse sheathing of retinal vessels, macular edema, papillitis, vitritis and anterior uveitis. We aimed to describe a case of frosted branch angiitis and cerebral venous sinus thrombosis as an initial neuro-Behçet's disease onset. Diagnosis of Behçet's disease was based on the current 2014 International Criteria for Behçet's Disease and the International consensus recommendation criteria for neuro-Behçet's disease. In addition, a literature review using search parameters of "frosted branch angiitis", "Behçet" and "neuro-Behçet" in the PubMed database is presented.. A 28-year-old Brazilian pardo woman presented to our hospital with abrupt bilateral vision loss associated with recurrent aphthous oral ulcers 6 months before visual symptom onset. A fundus examination showed bilateral widespread retinal vasculitis with venous and arterial white sheathing, optic disc swelling, macular edema, and retinal hemorrhages, leading to the diagnosis of frosted branch angiitis. An extensive systemic workup for retinal vasculitis was uneventful, except for brain magnetic resonance imaging demonstrating cerebral venous sinus thrombosis and lymphocytic aseptic meningitis. A diagnosis of neuro-Behçet's disease was made, and treatment was started with methylprednisolone therapy 1 g/day for 5 consecutive days, followed by oral mycophenolate mofetil and infliximab 5 mg/kg infusion. The patient's response was rapid, with improvement of visual acuity to hand movement and counting fingers by day 7 and final visual acuity of counting fingers and 20/130.. Frosted branch angiitis may be associated with infectious, noninfectious, or idiopathic causes. An extensive workup should be done to exclude systemic vasculitis such as Behçet's disease. Treatment with systemic steroids must be promptly initiated in association with specific treatment aimed at inflammation control and blindness risk reduction.

Topics: Adult; Antibiotics, Antineoplastic; Behcet Syndrome; Female; Fluorescein Angiography; Fundus Oculi; Humans; Magnetic Resonance Imaging; Methylprednisolone; Mycophenolic Acid; Oral Ulcer; Recovery of Function; Retinal Hemorrhage; Retinal Vasculitis; Sinus Thrombosis, Intracranial; Treatment Outcome; Vision Disorders

In an attempt to reduce calcineurin inhibitor toxicity, transplant patients treated with tacrolimus can be switched to maintenance treatment with sirolimus.. In a prospective, randomized, multicenter trial, 33 kidney transplant recipients on steroid-free maintenance treatment with tacrolimus and mycophenolate mofetil continued tacrolimus and mycophenolate mofetil (control group, n=18) or were converted from tacrolimus to sirolimus (study group, n=15) at 1 year after transplantation.. The study was prematurely stopped as a result of a cluster of nine patients suffering from painful oral ulcerations in the study group. Oral ulcerations did not occur in the control group. The authors here report on the individual cases suffering from this side effect of the instituted immunosuppressive regimen.. The authors review the literature with respect to the occurrence of oral ulcers associated with the use of sirolimus or mycophenolate mofetil and speculate on the causes of the high incidence of oral ulcers in their study group. Possible explanations are overimmunosuppression during the period of the conversion from tacrolimus to sirolimus without antiviral prophylaxis, the use of the oral emulsion instead of tablets, or the lack of corticosteroid co-administration.

Topics: Adult; Aged; Female; Graft Rejection; Humans; Immunosuppressive Agents; Incidence; Kidney Transplantation; Male; Middle Aged; Mycophenolic Acid; Oral Ulcer; Prospective Studies; Sirolimus

Topics: Humans; Kidney Transplantation; Mouth Mucosa; Mycophenolic Acid; Oral Ulcer; Organ Transplantation

Mycophenolate Mofetil (MMF) is an immunosuppressive drug usually used in kidney transplants to prevent rejection. It has various adverse effects such as leucopenia, anemia, diarrhea but Mouth ulcers are rarely reported.. We present a case report of MMF-induced mouth ulcers in an African patient.. A 41-year-old African-male patient has painful oral ulcers which developed 5 months after kidney transplantation. The immunosuppressive maintenance regimen comprised Steroids, Tacrolimus and MMF.. These ulcers were firstly related to a fungic or viral infection so the patient was prescribed Fluconazole and Aciclovir without any improvement. Then, Tacrolimus blood level was checked and it was in a therapeutic range. Finally, we decide to stop MMF and the ulcers healed quickly.. Oral ulcers are frequently seen complications in immunosuppressant patient but are rarely described with MMF. These ulcers can become large and very painful and degrade patient's life quality. So when infections causes are excluded, we have to keep in mind that these ulcers can be a drug adverse effect.

Topics: Adult; Drug-Related Side Effects and Adverse Reactions; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Mycophenolic Acid; Oral Ulcer; Steroids; Tacrolimus; Transplant Recipients

The final diagnosis of oral mucosal ulcerations in solid organ transplant recipients represents a challenge. We describe a unique case of oral ulceration related to mycophenolate mofetil (MMF) toxicity, 11 years after kidney transplantation, whose dose reduction was sufficient to resolve it.. A 54-year-old female patient, who underwent kidney transplantation 11 years ago, presents multiple ulcers on the buccal mucosa bilaterally, soft palate and tongue dorsum, for 8 months, with moderate pain. The diagnosis of oral ulcerations associated with MMF therapy was assumed by excluding infection and malignancy diagnosis. After MMF dose reduction, the oral ulcers healed utterly.. MMF toxicity manifested as oral ulcers. Reduction or discontinuation of MMF therapy should be considered in a patient with refractory oral ulcers and a negative workup for other causes.

Topics: Female; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Middle Aged; Mycophenolic Acid; Oral Ulcer

Topics: Adolescent; Anti-Inflammatory Agents; Antibiotics, Antineoplastic; Castleman Disease; Diagnosis, Differential; Genital Diseases, Male; Humans; Immunoglobulins; Immunologic Factors; Male; Methylprednisolone; Mycophenolic Acid; Oral Ulcer; Pain; Retroperitoneal Space; Rituximab; Tomography, X-Ray Computed

Topics: Adult; Epstein-Barr Virus Infections; Female; Gingival Diseases; Glomerulonephritis, Membranoproliferative; Humans; Immunocompromised Host; Immunosuppressive Agents; Mycophenolic Acid; Oral Ulcer; Reed-Sternberg Cells; RNA, Viral

Topics: Actinomycosis; Antilymphocyte Serum; Humans; Immunosuppression Therapy; Kidney Transplantation; Male; Middle Aged; Mycophenolic Acid; Oral Ulcer; Tacrolimus; Transplantation, Homologous

Topics: Azathioprine; Cardiomyopathy, Dilated; Drug Substitution; Graft Rejection; Graft Survival; Heart Transplantation; Humans; Immunosuppressive Agents; Infant; Mycophenolic Acid; Oral Ulcer; Treatment Outcome

Medication-induced ulcerative stomatitis can be a complication of immunosuppressive therapy in a post-transplant patient. A 54-year-old African-American female patient presented with significant, recalcitrant oral ulcers 5 months after renal transplant as a result of mucosal toxicity and severe leucopenia caused by her immunosuppressive maintenance regimen of tacrolimus (US Pharmacopeia, Rockville, MD) and mycophenolate mofetil (Santa Cruz Biotechnology, Santa Cruz, CA). The patient was also prescribed fluconazole as an antifungal, which likely contributed to the patient's increase in tacrolimus blood levels. Altering the medication dosages ultimately reduced blood tacrolimus levels, allowing for resolution of her oral ulcers. This report indicates that medication-induced oral ulcerations are a potential sequela of post-transplant immunosuppressive therapy.

Topics: Female; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Middle Aged; Mycophenolic Acid; Oral Ulcer; Tacrolimus

A case study of mycophenolate mofetil-induced oral ulcers in a renal transplant patient is reported.. A 23-year-old Hispanic man who received a renal transplant from a living relative secondary to end-stage renal disease due to focal segmental glomerulosclerosis arrived at an outpatient clinic with gum swelling and pain. He had been on a maintenance immunosuppressive regimen consisting of cyclosporine 150 mg twice daily, mycophenolate mofetil 1 g twice daily, and prednisone 12.5 mg daily for approximately four months. Routine laboratory tests revealed an elevated serum creatinine concentration (2.2 mg/ dL) and a decreased white blood cell count (2.3 × 10(3)/μL). All other laboratory test values were within normal limits. Initially, cyclosporine-induced gingival hyperplasia was suspected. However, despite reduction of the cyclosporine dosage, the gum pain and swelling did not improve, and the patient began to complain of odynophagia and worsening of symptoms. On physical examination, scattered ulcerations on the gums and lips were noted. The diagnosis of oral ulcerations secondary to mycophenolate mofetil therapy was suspected when other etiologies, such as hematologic disorders, malignancies, and viral infections, were eliminated. Mycophenolate mofetil was discontinued. One week later, the patient's ulcers had regressed and odynophagia improved, as did his renal function and leukopenia. Mycophenolate mofetil was not restarted, and the patient reported complete resolution of symptoms six weeks after discontinuation of mycophenolate mofetil.. After five months of therapy, a 23-year-old renal transplant recipient developed mycophenolate mofetil toxicity manifested as oral ulcers. Discontinuation of therapy resulted in rapid resolution of oral ulcers.

Topics: Graft Rejection; Humans; Kidney Transplantation; Male; Mycophenolic Acid; Oral Ulcer; Young Adult

Topics: Adult; Enzyme Inhibitors; Female; Humans; Immunosuppressive Agents; Mycophenolic Acid; Oral Ulcer; Pancreas Transplantation; Sirolimus; Tacrolimus; Tongue Diseases

Topics: Adult; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Azathioprine; Diagnosis, Differential; Drug Therapy, Combination; Epstein-Barr Virus Infections; Female; Gingival Diseases; Hepatitis, Autoimmune; Herpesvirus 4, Human; Hodgkin Disease; Humans; Iatrogenic Disease; Immunocompromised Host; Immunosuppressive Agents; Lymphoproliferative Disorders; Mandibular Diseases; Mycophenolic Acid; Oral Ulcer; Prednisone; Remission Induction; Rituximab; Virus Activation

Linear IgA disease (LAD) is a rare acquired autoimmune bullous disorder, characterized by linear deposition of IgA along the dermoepidermal basement membrane zone. The clinical presentation of LAD consists of vesiculobullous lesions affecting the skin and mucosal surfaces. The present case report presents a rare presentation of this vesiculobullous disorder. Although more than 50% of LAD patients present with oral lesions, there are few reported cases of involvement of the mouth as the sole manifestation. A 79-year-old female presented with a sore mouth and erosions affecting the palate. The symptoms resolved following the provision of mycophenolate, an antiproliferative immunosuppressant which has not previously appeared to have been reported in the long-term successful management of linear IgA disease limited to the mouth. We found that mycophenolate is a useful adjunct to the successful treatment of oral linear IgA when the uses of other immunosuppressants are contraindicated.

Topics: Aged; Anti-Inflammatory Agents; Azathioprine; Diagnosis, Differential; Female; Fluorescent Antibody Technique; Fluorescent Antibody Technique, Direct; Gingival Diseases; Humans; Immunoglobulin A; Immunosuppressive Agents; Mycophenolic Acid; Oral Ulcer; Prednisolone; Skin Diseases, Vesiculobullous

Oral ulcers are a frequent problem in transplant medicine. It is important to consider infectious etiologies, exacerbated by the immunosuppressive treatment, but other etiologies are also possible, like adverse drug reactions. Mycophenolate mofetil (MMF) is an immunosuppressive medication that has been used in combination with calcineurin inhibitors and steroids. Reports of renal transplant patients with oral ulcers related to MMF have appeared lately and herein we have described 2 cases in liver transplant patients. Their oral ulcers resolved quickly after suspension of the medication. Our 2 cases in liver transplant patients represented a unique setting for this type of complication.

Topics: Adult; Anti-Bacterial Agents; Cyclosporine; Female; Humans; Immunosuppressive Agents; Liver Transplantation; Methicillin Resistance; Middle Aged; Mycophenolic Acid; Oral Ulcer; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Mycophenolate sodium (Myfortic) is an enteric-coated formulation of the immunosuppressant therapy mycophenolic acid. We report a case of diffuse mouth ulceration in a patient treated with Myfortic presenting recurrence after another dose of drug.. We report the case of a 26-year-old female patient with systemic lupus erythematosus, initially treated with corticosteroids and mycophenolate mofetil, but which was stopped because of varicella-zoster dissemination and leucopoenia. She consulted for mouth ulcers occurring two weeks after the introduction of Myfortic. There were no signs of opportunist infection or lupus activity. Mucosal ulcerations disappeared when Myfortic was stopped. Several weeks later, the patient presented recurrence of mouth ulcerations after another treatment of Myfortic.. Myfortic is a new enteric-coated formulation of mycophenolic acid developed to reduce gastrointestinal upset associated with Cellcept. In certain cases, Cellcept toxicity can present as a number of oral ulcerations. Direct toxicity is involved in these cases. This side effect has never been described with Myfortic. In our case, the distinctive characteristic is that the patient was never treated with Cellcept without mucosal toxicity despite equivalent systemic mycophenolic acid exposure.

Topics: Adult; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mycophenolic Acid; Oral Ulcer; Recurrence; Tablets, Enteric-Coated

Topics: Female; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Leukopenia; Middle Aged; Mycophenolic Acid; Oral Ulcer

Topics: Dermatologic Agents; Humans; Kidney Transplantation; Male; Middle Aged; Mycophenolic Acid; Oral Ulcer; Treatment Outcome

Topics: Humans; Immunosuppressive Agents; Kidney Transplantation; Middle Aged; Mycophenolic Acid; Oral Ulcer

Topics: Adult; Drug Therapy, Combination; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Hyperbilirubinemia; Immunosuppressive Agents; Infection Control; Leukemia, Monocytic, Acute; Male; Mycophenolic Acid; Oral Ulcer; Prednisone; PUVA Therapy; Tacrolimus; Transplantation, Homologous; Xerostomia

Pemphigus vulgaris, or PV, is a potentially life-threatening illness that manifests itself initially in the mouth in the majority of patients. Paradoxically, it is less commonly recognized when it involves lesions on the oral mucosa rather than on the skin.. This article describes the clinical presentation of 42 cases of oral PV evaluated and diagnosed by dentists. Emphasis is placed on the common distribution and appearance of oral PV lesions and diagnosis of the disease.. The dentist has a unique opportunity to recognize the oral presentation of PV and contribute to an early diagnosis and, therefore, an improved treatment outcome.

Topics: Adult; Aged; Anti-Inflammatory Agents; Autoantibodies; Azathioprine; Corneal Ulcer; Cyclophosphamide; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Mycophenolic Acid; Oral Ulcer; Pemphigus; Prednisolone