Liver transplantation
Oral Ulcers Produced by Mycophenolate Mofetil in Two Liver Transplant Patients

https://doi.org/10.1016/j.transproceed.2006.12.028Get rights and content

Abstract

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.

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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

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