Liver transplantationOral Ulcers Produced by Mycophenolate Mofetil in Two Liver Transplant Patients
Section snippets
Case 1
The first patient was a 60-year-old woman with a history of type 2 diabetes mellitus and chronic arterial hypertension. In May 2003, she displayed spontaneous bacterial peritonitis and hepatic encephalopathy. The liver cirrhosis was probably secondary to nonalcoholic steatohepatitis (Child B), complicated by portal hypertension, esophagic varices, portal gastropathy, and ascites. The laboratory tests highlighted cytomegalovirus (CMV) IgG positive; toxoplasmosis IgG positive 1:16; and
Case 2
The second patient was a 31-year-old woman who gave birth to twins 11 months prior without complications, and regularly took acetaminophen and piroxicam olamine for polyarthralgias. By the middle of July 2005, she showed symptoms of asthenia, jaundice, and choluria, followed by lapses in consciousness. In August, she was hospitalized in Copiapó, with subacute liver failure and hepatic encephalopathy G III. Immunological tests showed hepatitis A virus (HAV) IgM negative, hepatitis B surface
Discussion
Oral ulcers induced by drugs are well known, but are unfortunately paid little attention, and the underlying mechanisms are unknown. It is critical to have the details of medications to be able to attribute the oral ulcers to an adverse drug reaction, especially when they are treatment-resistant, or when their cause is unknown. It is also important to define when the ulcerations began or if they worsened de novo upon an increased dosage. Some patients with drug-induced oral ulcers improve with
References (9)
- et al.
Unexpected augmentation of mycophenolic acid pharmacokinetics in renal transplant patients receiving tacrolimus and mycophenolate mofetil in combination therapy, and analogous in vitro findings
Transpl Immunol
(1997) - et al.
Review article: oral ulceration—aetiopathogenesis, clinical diagnosis and management in the gastrointestinal clinic
Aliment Pharmacol Ther
(2003) - et al.
Oral ulceration in a renal transplant recipient: a mycophenolate mofetil-induced complication?
Transplantation
(2001) - et al.
Oral ulcer in kidney transplant recipients treated with sirolimus and mycophenolate mofetil
Transplantation
(2003)