An unusual oral chronic graft-versus-host disease-like syndrome following a liver transplant.
BACKGROUND
Giving the immunosuppressive drug tacrolimus (FK506) to liver transplant patients has helped to considerably reduce oral side effects such as gingival hyperplasia. Patients taking cyclosporin who suffer from gingival hyperplasia are often switched to tacrolimus.


METHODS
We present here a pediatric liver transplantation case study. The patient has been followed for 5.5 years. She developed oral lesions that resulted in the immunosuppressive therapy being changed from tacrolimus to cyclosporin. In clinical terms, the atypical pathology consisted of hyperpigmented patches on the gingival margin, the internal surfaces of the cheeks, and the intraoral surfaces of the lips. When located on the lips, the hyperpigmented patches were associated with pruriginous and edematous lesions.


RESULTS
Optical and electronic microscopic examinations of a gingival tissue sample revealed the presence of melanin incontinence and lichenoid lesions with degenerated keratinocytes and a mild infiltrate of lymphocytes. This points to a chronic graft-versus-host disease (cGvHD)-like syndrome linked to tacrolimus. This diagnosis was given further credence by improvement in the lesions following the switch to cyclosporin.


CONCLUSIONS
To our knowledge, this is the first reported case of tacrolimus-associated chronic GvHD-like syndrome occurring in the oral mucosa.
Bunetel
Laurence
L
Laboratory of Oral Biology, Department of Pediatric Dentistry, Rennes, France. laurence.bunetel@univ-rennes1.fr
Le Gall
François
F
Delaval
Yvonne
Y
Sixou
Jean-Louis
JL
Dabadie
Alain
A
Bonnaure-Mallet
Martine
M
D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D005882:Gingival Diseases / Q000139:chemically induced*; D006086:Graft vs Host Disease / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007223:Infant; D017676:Lichen Planus, Oral / Q000139:chemically induced; D016031:Liver Transplantation / Q000009:adverse effects*; D008548:Melanosis / Q000139:chemically induced*; D011536:Prurigo / Q000139:chemically induced; D016559:Tacrolimus / Q000009:adverse effects*
D007166:Immunosuppressive Agents; D016559:Tacrolimus