Resolution of oral ulcerations after decreasing the dosage of tacrolimus in a liver transplantation recipient

Hernández, Gonzalo; Jiménez, Carlos María Gómez-Centurión; Arriba, Lorenzo de; Moreno, Enrique; Lucas, Miguel

doi:10.1067/moe.2001.116152

Cited by 27 publications

(23 citation statements)

References 37 publications

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“…Some side effects include neurotoxicity (headache, tremor, and insomnia), nephrotoxicity, and metabolic disturbances such as hyperkalemia, hyperuricemia, hyperlipidemia, hypomagnesemia, and diabetes mellitus 8,9 . With regard to dermatologic reactions to tacrolimus, oral ulcers also have been recognized as an occasional complication, with improvement or resolution of stomatitis after a decrease in dose 2,4 . Other effects, although infrequent, include pruritus, acneiform eruptions, alopecia, hirsutism, and exfoliative dermatitis.…”

Section: Discussionmentioning

confidence: 99%

“…The cause of aphthae associated with sirolimus and tacrolimus remains obscure; however, immunosuppression appears to be an important factor in all of these cases. Increasing reports of painful aphthous ulcerations caused by tacrolimus 2,4 and sirolimus 3,5,6,8,10,11 underscore the importance of recognizing this association.…”

Section: Discussionmentioning

confidence: 99%

“…Although their exact etiology remains unknown, aphthous ulcers can be precipitated by various factors. This condition has been associated with sirolimus and tacrolimus 2–4 . The frequency of aphthae in transplant recipients receiving sirolimus ranges from 20 to 60% 3,5,6 .…”

Section: Introductionmentioning

confidence: 99%

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Severe aphthous stomatitis associated with oral calcineurin and mTOR inhibitors

et al. 2009

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Severe aphthous stomatitis associated with oral calcineurin and mTOR inhibitors

et al. 2009

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“…Oral stomatitis in transplanted patients could be associated with type of immunosuppressive medication, viral or Candida albicans. In some cases, replacement or decreasing the dosage of immunosuppressive drugs is necessary [35,36,42].…”

Section: Oral Manifestations Of Fungal and Viral Infections In Immunomentioning

confidence: 99%

Oral health protocol for liver transplant patients

Lins¹,

Bastos²

2014

Transplant Technol

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Chronic liver disease and cirrhosis were the ninth leading cause of death in Brazil in 2011. Infectious complications are major factors for morbidity and mortality in liver transplant recipients. Oral infection is a cause of systemic infection for both liver transplant candidates and recipients. Liver transplant patients are at high risk of oral infection and preventive measures are mandatory. Oral treatment is feasible to the majority of patients awaiting liver transplantation. However, protocols for oral lesions management in liver transplant patients are not established in literature yet. The aim of the present study is to describe an oral health protocol for liver transplant patients based in our 12 years of experience in diagnosing and treating oral disease in the Liver Transplantation Clinic, Federal University of Bahia, Brazil. This protocol was developed by a multidisciplinary team of transplant surgeons, hepatologists, transplant nurses and dentists. All patients are evaluated by the hepatology team that assess liver disease severity and refer them to oral care. The oral assessment is carefully carried out. Additional complementary examinations are necessary to conclude diagnosis and proceed to an individual treatment plan. When oral surgery is necessary, coagulation factors, liver disease severity and the extent of surgical procedure are evaluated for each patient.

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“…In most drug-induced oral reactions, improvement of clinical symptoms occurs after dose reduction or upon discontinuation of the off ending drug 4,5 . Hernandez et al 6 have described a case of a patient in whom resolution of oral ulceration occurred after decreasing the dosage of tacrolimus. It seems that this phenomenon may be related to the drug half-life.…”

Section: Introductionmentioning

confidence: 99%

Drug-Induced Oral Ulcerations: Case Report

Boras

Židovec-Lepej

Marinović

et al. 2016

ACC

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SUMMARY -A 70-year-old patient was admitted to the Department of Oral Medicine for multiple oral ulcerations on the left buccal mucosa, around 0.5 cm in diameter, as well as on the gingiva. Otherwise, the patient suff ered from chronic lymphocytic leukemia, hypogammaglobulinemia, chronic renal insuffi ciency, with complete afunction of the right kidney, asthma, hypertension, gastritis and prostate hyperplasia. Diff erential diagnosis of oral ulcerations included drug induced oral ulcerations, paraneoplastic pemphigus, viral ulcerations (cytomegalovirus, herpes simplex viruses), fungal ulcerations (candidiasis, aspergillosis, histoplasmosis, cryptococcosis) and bacterial ulcerations, as well as neutropenic ulcers. One of the possible explanations was that the lesions were due to the use of drugs, the more so as oral lesions evolved when the doses of allopurinol and chlorambucil were increased, and subsided when the doses of both drugs were decreased. However, we could not establish for sure whether the lesions were due to allopurinol or chlorambucil. According to literature data, allopurinol is one of the most frequent drugs known to induce skin adverse reactions, therefore we assumed that it was the culprit drug. Unfortunately, several weeks later the patient died from sepsis, pneumonia with respiratory insuffi ciency and multiorgan failure.

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Resolution of oral ulcerations after decreasing the dosage of tacrolimus in a liver transplantation recipient

Cited by 27 publications

References 37 publications

Severe aphthous stomatitis associated with oral calcineurin and mTOR inhibitors

Severe aphthous stomatitis associated with oral calcineurin and mTOR inhibitors

Oral health protocol for liver transplant patients

Drug-Induced Oral Ulcerations: Case Report

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