Oral ulcers associated with mycophenolate mofetil use in a renal transplant recipient

Weng, Renee R.; Foster III, Clarence E.; Hsieh, Lanny L.; Patel, Puja R.
April 2011
American Journal of Health-System Pharmacy;4/1/2011, Vol. 68 Issue 7, p585
Academic Journal
Case Study
Purpose. A case study of mycophenolate mofetil-induced oral ulcers in a renal transplant patient is reported. Summary. A 23-year-old Hispanic man who received a renal transplant from a living relative secondary to end-stage renal disease due to focal segmental glomerulosclerosis arrived at an outpatient clinic with gum swelling and pain. He had been on a maintenance immunosuppressive regimen consisting of cyclosporine 150 mg twice daily, mycophenolate mofetil 1 g twice daily, and prednisone 12.5 mg daily for approximately four months. Routine laboratory tests revealed an elevated serum creatinine concentration (2.2 mg/dL) and a decreased white blood cell count (2.3 × 103/µL). All other laboratory test values were within normal limits. Initially, cyclosporine-induced gingival hyperplasia was suspected. However, despite reduction of the cyclosporine dosage, the gum pain and swelling did not improve, and the patient began to complain of odynophagia and worsening of symptoms. On physical examination, scattered ulcerations on the gums and lips were noted. The diagnosis of oral ulcerations secondary to mycophenolate mofetil therapy was suspected when other etiologies, such as hematologic disorders, malignancies, and viral infections, were eliminated. Mycophenolate mofetil was discontinued. One week later, the patient's ulcers had regressed and odynophagia improved, as did his renal function and leukopenia. Mycophenolate mofetil was not restarted, and the patient reported complete resolution of symptoms six weeks after discontinuation of mycophenolate mofetil. Conclusion. After five months of therapy, a 23-year-old renal transplant recipient developed mycophenolate mofetil toxicity manifested as oral ulcers. Discontinuation of therapy resulted in rapid resolution of oral ulcers.


Related Articles

  • Prevention of organ rejection in renal and liver transplantation with extended release tacrolimus. Reschen, Michael E.; O'Callaghan, Christopher A. // Transplant Research & Risk Management;2014, Vol. 6, p55 

    Tacrolimus is the key immunosuppressant used to prevent allograft rejection in kidney and liver transplant recipients. Despite the efficacy of tacrolimus and adjunctive immunosuppressants, a substantial number of patients experience episodes of acute rejection and late graft loss. Nonadherence...

  • Early graft dysfunction in a child with renal transplantation: question. Otukesh, Hasan; Hoseini, Rozita; Torbati, Peyman; Hekmat, Sepideh; Azimi, Sarah // Pediatric Nephrology;Feb2011, Vol. 26 Issue 2, p217 

    The article presents a case study, which is part of a clinical quiz, of an eleven-year old girl who experienced early graft dysfunction following a renal transplantation using tissue from a living, unrelated organ donor. Topics include an overview of the histopathological findings for the...

  • Induction Therapy in Renal Transplantation: An Overview of Current Developments. Ciancio, Gaetano; Burke, George W.; Miller, Joshua // Drugs;2007, Vol. 67 Issue 18, p2667 

    An overview of the past 10 years of clinical renal transplantation would include progress in the development of new induction protocols (non-depleting versus depleting monoclonal and polyclonal antibodies, plasmapheresis and intravenous immunoglobulins) designed to reduce the incidence and...

  • Population pharmacokinetic study of cyclosporine in Chinese renal transplant recipients. Chen, Bing; Zhang, WeiXia; Gu, ZhiDong; Li, Juan; Zhang, YuXin; Cai, WeiMin // European Journal of Clinical Pharmacology;Jun2011, Vol. 67 Issue 6, p601 

    Purpose: To establish the population pharmacokinetic (PPK) model of cyclosporine (CsA) in Chinese renal transplant recipients and evaluate the influence of various indexes including CYP3A5 and MDR1 genetic polymorphism on pharmacokinetic parameters. Methods: Trough (C) and peak (C) CsA...

  • Ciclosporin + azathioprine a "valid alternative" in renal transplantation.  // PharmacoEconomics & Outcomes News;9/20/2008, Issue 562, p5 

    The article focuses on the validity of a regimen of ciclosporin plus azathioprine as an alternative to tacrolimus plus mycophenolate mofetil regimen for preventing acute renal transplant rejection, based on a study from France. The results were tackled at the 22nd International Congress of the...

  • Basiliximab Injection.  // AHFS Consumer Medication Information;Sep2016, p1 

    Basiliximab injection is used with other medications to prevent immediate transplant rejection (attack of the transplanted organ by the immune system of the person receiving the organ) in people who are receiving kidney transplants. Basiliximab injection is in a class of medications called...


    Since the first renal transplantation, rejection prevention and control have been main aims of medical research. While acute rejection rates have fallen to 10-15% at 1 year, chronic rejection still erode long-term transplant potential. Current drugs for prevention and treatment of renal...

  • Enteric-Coated Mycophenolate Sodium: A Review of its Use in the Prevention of Renal Transplant Rejection. Sanford, Mark; Keating, Gillian M. // Drugs;2008, Vol. 68 Issue 17, p2505 

    Enteric-coated mycophenolate sodium (Myfortic®) is a reversible, noncompetitive inosine monophosphate dehydrogenase (IMPDH) inhibitor that is approved in the EU, the US and in other countries worldwide for immunosuppressive prophylaxis against graft rejection in adult renal transplant...

  • Influence of Post-Transplant Immunosuppressive Therapy on Gastrointestinal Transit Using Biomagnetic Method: A Pilot Study. Teixeira, Maria do; Américo, Madileine; Oliveira, Ricardo; Miranda, José; Romeiro, Fernando; Corá, Luciana // Digestive Diseases & Sciences;Jan2015, Vol. 60 Issue 1, p174 

    Background: Immunosuppressive therapy after kidney transplant is necessary to prevent allograft rejection and it is the cause of several gastrointestinal (GI) disorders that have been scantily studied. Objectives: This study was aimed at investigating the influence of triple immunosuppressive...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics