Diagnosis and management of oral ulcerations associated with mycophenolate mofetil in kidney transplantation

Abstract

Aims 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. Methods and results 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. Conclusions 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.

Oral findings in kidney transplant children and adolescents

“…Two participants had oral ulcers at the time of examination, and we found a positive relationship with the use of everolimus. Such a relationship has already been described elsewhere 36–39 . In this study, five patients were on everolimus and two of them had oral ulcers at the moment of clinical examination.…”

“…In severe cases, it may be necessary to modify the immunosuppressant regimen for healing oral ulcers, and always taking into account that this decision should be made jointly by physician and nephrologist. 36,38 Because this is a cross-sectional study, we could not establish a cause-and-effect relationship between the use of everolimus and the presence of oral ulcers as well as between enamel hypoplasia and time on haemodialysis.…”

“…Such a relationship has already been described elsewhere. [36][37][38][39] In this study, five patients were on everolimus and two of them had oral ulcers at the moment of clinical examination. Individuals taking this immunosuppressant are eight times more likely to have ulcers in the oral mucosa.…”

“…Individuals taking this immunosuppressant are eight times more likely to have ulcers in the oral mucosa. In severe cases, it may be necessary to modify the immunosuppressant regimen for healing oral ulcers, and always taking into account that this decision should be made jointly by physician and nephrologist 36,38 …”

Mycophenolate Mofetil-Induced Aphthous Stomatitis After Kidney Transplant: A Clinical Case Report

“…A handful of case reports have been published in the literature regarding the development of oral ulcerations stemming from mycophenolate mofetil among kidney transplant recipients [2,[6][7][8][12][13][14][15]. Table 2 summarizes the case report literature on mycophenolate mofetil-induced oral ulcers in kidney transplant recipients.…”