title: Severe aphthous stomatitis associated with oral calcineurin and mTOR inhibitors.
abstract: BACKGROUND
  Aphthous stomatitis, a common mucocutaneous disorder, is a well accepted complication of sirolimus therapy. This association has been reported less frequently with tacrolimus.
  
  
  METHODS
  We present an 11-year old male with Budd-Chiari syndrome who experienced profound worsening of chronic aphthous ulcers after immunosuppressive therapy was changed from tacrolimus to sirolimus.
  
  
  CONCLUSIONS
  Since these drugs are used widely in the pediatric transplantation population, this report serves to heighten awareness of this debilitating phenomenon, and to stress the importance of exercising caution when sirolimus and tacrolimus are administered in combination to pediatric patients.
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Habib
authors.forename: Cristina
authors.initials: C
authors.lastname: Salaro
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Ghaithi
authors.forename: Robert G
authors.initials: RG
authors.lastname: Phelps
authors.forename: Sarika
authors.initials: S
authors.lastname: Saggar
authors.forename: Steven R
authors.initials: SR
authors.lastname: Cohen
mesh_terms: D000284:Administration, Oral; D006502:Budd-Chiari Syndrome / Q000188:drug therapy*; D065095:Calcineurin Inhibitors; D002648:Child; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D047908:Intracellular Signaling Peptides and Proteins / Q000037:antagonists & inhibitors*; D008297:Male; D017346:Protein Serine-Threonine Kinases / Q000037:antagonists & inhibitors*; D012720:Severity of Illness Index; D020123:Sirolimus / Q000009:adverse effects*; D013281:Stomatitis, Aphthous / Q000139:chemically induced*; D058570:TOR Serine-Threonine Kinases; D014060:Tongue Diseases / Q000139:chemically induced
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D047908:Intracellular Signaling Peptides and Proteins; C546842:MTOR protein, human; D017346:Protein Serine-Threonine Kinases; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus