Introduction:
Mycophenolate Mofetil (MMF) is an immunosuppressive drug usually
used in kidney transplants to prevent rejection. It has various adverse effects such as leucopenia,
anemia, diarrhea but Mouth ulcers are rarely reported.
Methods:
We present a case report of MMF-induced mouth ulcers in an African patient.
Case Report:
A 41-year-old African-male patient has painful oral ulcers which developed 5 months
after kidney transplantation. The immunosuppressive maintenance regimen comprised Steroids,
Tacrolimus and MMF.
Results:
These ulcers were firstly related to a fungic or viral infection so the patient was prescribed
Fluconazole and Aciclovir without any improvement. Then, Tacrolimus blood level was checked
and it was in a therapeutic range. Finally, we decide to stop MMF and the ulcers healed quickly.
Discussion:
Oral ulcers are frequently seen complications in immunosuppressant patient but are
rarely described with MMF. These ulcers can become large and very painful and degrade patient's
life quality. So when infections causes are excluded, we have to keep in mind that these ulcers can
be a drug adverse effect.
Background and Aims
The B cells have a central role in the pathogenesis of several renal pathologies. Rituximab, a monoclonal antibody directed against the CD20 receptor expressed on the surface of B cells is an interesting alternative to conventional treatments of kidney pathologies.
Method
We conducted a descriptive retrospective study of the use of rituximab in nephrology patients.
Results
We collected 25 patients including 12 women and 13 men. The mean age was 33,5 [16-55] years. The rituximab was indicated for an extramembranous glomerulopathy in 6 patients, a focal segmental glomerulosclerosis in 4 patients, a minimal change disease in 4 patients, a lupus nephritis in 5 patients, and a granulomatosis with polyangiitis in 2 patients. Four kidney transplant patient received rituximab for the treatment of antibody mediated rejection in 3 cases and large cell lymphoma in 1 case.
The average time between the diagnosis of the renal disease and starting treatment with rituximab was of 76 +/- 46,5 months. And it was of 16 [ 0,7 ; 59,8] months after transplantation in kidney transplant recipients.
Side effects have been observed in 11 cases (44%). A favorable response has been obtained in 10 cases (40 %), within an average of 2,27 months, with at least one relapse in 4 cases. The follow-up time was 36,33 +/- 31,67 months.
Conclusion
Rituximab has been shown to be helpful in several cases of kidney disease. It may reduce the need for maintenance immunosuppression and help in some cases that are refractory to other therapies.
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