title: Oral ulcerations as a sequela of tacrolimus and mycophenolate mofetil therapy.
abstract: Medication-induced ulcerative stomatitis can be a complication of immunosuppressive therapy in a post-transplant patient. A 54-year-old African-American female patient presented with significant, recalcitrant oral ulcers 5 months after renal transplant as a result of mucosal toxicity and severe leucopenia caused by her immunosuppressive maintenance regimen of tacrolimus (US Pharmacopeia, Rockville, MD) and mycophenolate mofetil (Santa Cruz Biotechnology, Santa Cruz, CA). The patient was also prescribed fluconazole as an antifungal, which likely contributed to the patient's increase in tacrolimus blood levels. Altering the medication dosages ultimately reduced blood tacrolimus levels, allowing for resolution of her oral ulcers. This report indicates that medication-induced oral ulcerations are a potential sequela of post-transplant immunosuppressive therapy.
authors.affiliation: Assistant Professor and Assistant Attending in Oral & Maxillofacial Pathology, Columbia University College of Dental Medicine. Electronic address: ep2464@cumc.columbia.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Philipone
authors.affiliation: Student Researcher, Columbia University College of Dental Medicine.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rockafellow
authors.affiliation: Resident, Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine.
authors.forename: Ronit
authors.initials: R
authors.lastname: Sternberg
authors.affiliation: Associate Professor/Attending Pathologist, Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine.
authors.forename: Angela
authors.initials: A
authors.lastname: Yoon
authors.affiliation: Assistant Professor/Attending Surgeon, Department of Oral and Maxillofacial Surgery, Columbia University College of Dental Medicine.
authors.forename: David
authors.initials: D
authors.lastname: Koslovsky
mesh_terms: D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D019226:Oral Ulcer / Q000139:chemically induced*; D016559:Tacrolimus / Q000009:adverse effects*
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus