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Jana BK, Singh M, Dutta RS, Mazumder B. Current Drug Delivery Strategies for Buccal Cavity Ailments using Mouth Dissolving Wafer Technology: A Comprehensive Review on the Present State of the Art. Curr Drug Deliv 2024; 21:339-359. [PMID: 36443976 DOI: 10.2174/1567201820666221128152010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/02/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mouth-dissolving wafer is polymer-based matrice that incorporates various pharmaceutical agents for oral drug delivery. This polymeric wafer is ingenious in the way that it needs not be administered with water, like in conventional tablet dosage form. It has better compliance among the pediatric and geriatric groups owing to its ease of administration. OBJECTIVE The polymeric wafer dissolves quickly in the oral cavity and is highly effective for a targeted local effect in buccal-specific ailments. It is a safe, effective, and versatile drug delivery carrier for a range of drugs used to treat a plethora of oral cavity-specific ailments that inflict common people, like thrush, canker sores, periodontal disease, benign oral cavity tumors, buccal neoplasm, and malignancies. This review paper focuses thoroughly on the present state of the art in mouth-dissolving wafer technology for buccal drug delivery and targeting. Moreover, we have also addressed present-time limitations associated with wafer technology to aid researchers in future developments in the arena of buccal drug delivery. CONCLUSION This dynamic novel formulation has tremendous future implications for designing drug delivery systems to target pernicious ailments and diseases specific to the buccal mucosa. In a nutshell, this review paper aims to summarize the present state of the art in buccal targeted drug delivery.
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Affiliation(s)
- Bani Kumar Jana
- Department of Pharmaceutical sciences, Dibrugarh University, Dibrugarh-786004, Assam, India
| | - Mohini Singh
- Department of Pharmaceutical sciences, Dibrugarh University, Dibrugarh-786004, Assam, India
| | - Rajat Subhra Dutta
- Department of Pharmaceutical sciences, Dibrugarh University, Dibrugarh-786004, Assam, India
| | - Bhaskar Mazumder
- Department of Pharmaceutical sciences, Dibrugarh University, Dibrugarh-786004, Assam, India
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2
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Almeslet A. Mycophenolate Mofetil-Induced Aphthous Stomatitis After Kidney Transplant: A Clinical Case Report. Cureus 2023; 15:e50811. [PMID: 38249270 PMCID: PMC10797224 DOI: 10.7759/cureus.50811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Aphthous stomatitis, with frequent and painful aphthous ulcers (also called canker sores or simply oral ulcers) on the non-keratinized oral mucous membranes, is often a cutaneous complication in kidney transplant recipients. Mycophenolate mofetil is a drug that is part of an immunosuppressive regimen in kidney transplant recipients, along with corticosteroids and calcineurin inhibitors. Mycophenolate mofetil, the triggering agent for mouth ulcers in kidney transplant recipients, has been communicated in scientific literature. Herein, we report a case of multiple painful oral ulcerations secondary to mycophenolate mofetil in a 23-year-old female kidney transplant recipient. The oral ulcers resolved immediately after discontinuation of the mycophenolate mofetil. Withdrawal of mycophenolate mofetil or switching to other medicine must be considered when a patient with a kidney transplant history complains of oral ulcers and a negative workup for other etiologies.
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Affiliation(s)
- Asma Almeslet
- Department of Oral Maxillofacial Surgery and Diagnostic Sciences, Riyadh Elm University, Riyadh, SAU
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3
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Asare K, Gatzke CB. Mycophenolate-induced oral ulcers: Case report and literature review. Am J Health Syst Pharm 2020; 77:523-528. [PMID: 32058566 DOI: 10.1093/ajhp/zxz358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE A case of mycophenolate mofetil (MMF)-induced oral ulceration in a kidney transplant recipient is reported. SUMMARY A 54-year-old man who had received a kidney transplant 7 months previously reported to our outpatient clinic with severe oral ulcers with odynophagia and was admitted to the hospital. His maintenance immunosuppressive agents at the time of admission consisted of tacrolimus and mycophenolate. The patient had stable renal function, with all laboratory values within normal ranges. After various alternative etiologies were ruled out, drug-induced oral ulceration was suspected, and the patient's tacrolimus dose was empirically reduced, resulting in reduction of the trough concentration from 10 ng/mL to 3.3 ng/mL without improvement of the ulceration. Mycophenolate-induced oral ulceration was suspected, and MMF was discontinued. Within 5 days of discontinuation, there was a remarkable improvement in both the size and severity of the ulceration, and the patient was discharged from the hospital. During the next clinic visit (a total of 12 days after MMF was discontinued), the patient's mouth and esophageal ulcers had completely healed. Six weeks after complete resolution of the ulcer, MMF at a dosage of 250 mg twice daily was initiated; the dosage was subsequently increased to 500 mg twice daily without a recurrence of ulceration. CONCLUSION A 54-year-old man developed oral ulceration after 7 months of MMF therapy. Discontinuation of therapy resulted in prompt resolution of the patient's ulcers, with no recurrence of ulceration at a lower MMF dose. This is the first case report indicating that mycophenolate-induced ulceration may be dose dependent.
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Affiliation(s)
- Kwame Asare
- Department of Pharmacy, St. Thomas Hospital West, Nashville, TN
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4
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Tenório JR, Tuma M, Martins F, Ortega KL, Cristelli M, Gallottini M. Diagnosis and management of oral ulcerations associated with mycophenolate mofetil in kidney transplantation. SPECIAL CARE IN DENTISTRY 2020; 40:605-610. [PMID: 32950040 DOI: 10.1111/scd.12522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022]
Abstract
AIMS The final diagnosis of oral mucosal ulcerations in solid organ transplant recipients represents a challenge. We describe a unique case of oral ulceration related to mycophenolate mofetil (MMF) toxicity, 11 years after kidney transplantation, whose dose reduction was sufficient to resolve it. METHODS AND RESULTS A 54-year-old female patient, who underwent kidney transplantation 11 years ago, presents multiple ulcers on the buccal mucosa bilaterally, soft palate and tongue dorsum, for 8 months, with moderate pain. The diagnosis of oral ulcerations associated with MMF therapy was assumed by excluding infection and malignancy diagnosis. After MMF dose reduction, the oral ulcers healed utterly. CONCLUSIONS MMF toxicity manifested as oral ulcers. Reduction or discontinuation of MMF therapy should be considered in a patient with refractory oral ulcers and a negative workup for other causes.
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Affiliation(s)
- Jefferson R Tenório
- Special Care Dentistry Center, School of Dentistry of the University of São Paulo, São Paulo, Brazil
| | - Marina Tuma
- Special Care Dentistry Center, School of Dentistry of the University of São Paulo, São Paulo, Brazil
| | - Fabiana Martins
- Special Care Dentistry Center, School of Dentistry of the University of São Paulo, São Paulo, Brazil.,Dental School, University of Santo Amaro, São Paulo, Brazil
| | - Karem L Ortega
- Special Care Dentistry Center, School of Dentistry of the University of São Paulo, São Paulo, Brazil
| | - Marina Cristelli
- Department of Nephrologist, Oswaldo Ramos Foundation Kidney Hospital, São Paulo, Brazil
| | - Marina Gallottini
- Special Care Dentistry Center, School of Dentistry of the University of São Paulo, São Paulo, Brazil
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5
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Perricone C, Ceccarelli F, Spinelli FR, Truglia S, Priori R, Valesini G, Conti F. Management of mycophenolate mofetil-induced acne in patients with Systemic Lupus Erythematosus: report of four cases and review of the literature. Mediterr J Rheumatol 2018; 29:217-220. [PMID: 32185330 PMCID: PMC7045945 DOI: 10.31138/mjr.29.4.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/04/2022] Open
Abstract
Background Mycophenolate mofetil (MMF) is an immunosuppressive drug currently used to treat Systemic Lupus Erythematosus (SLE). In addition to clinical efficacy, MMF use is also supported by a favorable profile of tolerance, with main side effects being nausea, diarrhea, headache, and, less frequently, leucopoenia. Acne is a relatively frequent adverse reaction to MMF that requires specific treatment and drug suspension. Investigations Herein, we describe four cases of MMF-induced acne, none reporting past medical history of acne. The patients were diagnosed with SLE and lupus nephritis and treated with MMF. They developed papulo-pustular and nodular skin lesions consistent with acne. The lesions occasionally showed the appearance of macrocomedones or of unusual, nodular, oedematous lesions in gluteal region, or they had abscess-like features. Culture test demonstrated the presence of Staphylococcus Aureus. They resolved after MMF withdrawal and therapy with tetracycline and local pseudomonic-acid. Conclusions Staphylococcus Aureus skin-localized infections inducing inflammatory/infectious acne may be a relatively frequent side-effect of MMF therapy in SLE. As soon as generalized, severe infections, due to Staphylococcus Aureus, may also occur in patients treated with MMF and even if antibiotics therapy is usually relatively effective, at least temporary MMF suspension may be suggested.
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Affiliation(s)
- Carlo Perricone
- Lupus Clinic, Sezione di Reumatologia, Dipartimento di Medicina Interna, Sapienza Università di Roma, Rome, Italy
| | - Fulvia Ceccarelli
- Lupus Clinic, Sezione di Reumatologia, Dipartimento di Medicina Interna, Sapienza Università di Roma, Rome, Italy
| | - Francesca Romana Spinelli
- Lupus Clinic, Sezione di Reumatologia, Dipartimento di Medicina Interna, Sapienza Università di Roma, Rome, Italy
| | - Simona Truglia
- Lupus Clinic, Sezione di Reumatologia, Dipartimento di Medicina Interna, Sapienza Università di Roma, Rome, Italy
| | - Roberta Priori
- Lupus Clinic, Sezione di Reumatologia, Dipartimento di Medicina Interna, Sapienza Università di Roma, Rome, Italy
| | - Guido Valesini
- Lupus Clinic, Sezione di Reumatologia, Dipartimento di Medicina Interna, Sapienza Università di Roma, Rome, Italy
| | - Fabrizio Conti
- Lupus Clinic, Sezione di Reumatologia, Dipartimento di Medicina Interna, Sapienza Università di Roma, Rome, Italy
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6
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Immunosuppressive drugs and the gastrointestinal tract in renal transplant patients. Transplant Rev (Orlando) 2018; 33:55-63. [PMID: 30473173 DOI: 10.1016/j.trre.2018.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/07/2018] [Accepted: 11/10/2018] [Indexed: 12/26/2022]
Abstract
Gastrointestinal (GI) discomfort is common after renal transplantation and can be caused by the use of various immunosuppressive drugs. GI symptoms affect the quality of life, lead to an impaired graft survival and an increased mortality. Moreover, diseases and disturbances of the GI tract also affect the pharmacokinetics of immunosuppressive drugs. This review addresses the interaction between immunosuppressive agents and GI disorders. The GI tract is involved in the metabolism of several immunosuppressive drugs. Calcineurin inhibitors, mTor inhibitors, and corticosteroids are subjected to metabolism by the intestinal cytochrome P450 (CYP3A) and by the drug efflux pump ABCB1. Mycophenolate is partly metabolized in the stomach and intestine and undergoes enterohepatic recirculation. Gastrointestinal disturbances can lead to a modified exposure to immunosuppressive drugs. In the first and second part of this review, we focus on the role of the GI tract in the pharmacokinetics of the immunosuppressive drugs and how to adjust immunosuppressive therapy in patients with vomiting, need for tube feeding, delayed gastric emptying, intestinal resection, and diarrhea. In the third part, we review the GI adverse effects of the various immunosuppressive drugs, with special attention for diarrhea and dyspepsia. Finally, we discuss the effects of drugs used for relief of GI complaints on the exposure to immunosuppressive agents.
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7
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Plana-Pla A, Solé LC, Garcia AB, Valdemoros RL. Mycophenolate mofetil-induced mouth ulcers in a kidney transplant patient: Case report and literature review. Nefrologia 2018; 39:80-83. [PMID: 30082101 DOI: 10.1016/j.nefro.2018.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/03/2018] [Accepted: 05/06/2018] [Indexed: 11/30/2022] Open
Abstract
Mouth ulcers are a cutaneous complication that can often affect kidney transplant patients, mostly due to the effect of immunosuppressive treatment. Even so, before asserting that said complication is indeed secondary to drugs, it is very important to establish a differential diagnosis with other mouth ulcer causes, such as systemic diseases or viral infections, which are also common in these patients.
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Affiliation(s)
- Adrià Plana-Pla
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Laura Cañas Solé
- Department of Nephrology, Hospital Universitari, Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Aram Boada Garcia
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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8
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Miuma S, Miyaaki H, Miyazoe Y, Suehiro T, Sasaki R, Shibata H, Taura N, Nakao K. Development of Duodenal Ulcers due to the Discontinuation of Proton Pump Inhibitors After the Induction of Sofosbuvir Plus Ledipasvir Therapy: A Report of Two Cases. Transplant Proc 2018; 50:222-225. [PMID: 29407313 DOI: 10.1016/j.transproceed.2017.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 10/17/2017] [Accepted: 12/05/2017] [Indexed: 12/13/2022]
Abstract
Sofosbuvir plus ledipasvir (SOF-LDV) combination therapy is a promising therapy for post-transplant hepatitis C virus (HCV) reinfection. It is known that gastric pH elevation induces lower absorption of ledipasvir; therefore, the use of proton pump inhibitors (PPIs) should be considered regarding dose reduction after SOF-LDV therapy induction. Here, we report two patients who developed duodenal ulcers due to the discontinuation of PPIs after the induction of SOF-LDV therapy for post-transplant HCV reinfection. The first patient was a 71-year-old man who had undergone living donor liver transplantation due to HCV-related liver cirrhosis. Lansoprazole, 30 mg daily, was discontinued upon SOF-LDV therapy induction. Seven days after SOF-LDV therapy induction, gastrointestinal endoscopy revealed the presence of a duodenal ulcer. The second patient was a 54-year-old man who had undergone living donor liver transplantation due to HCV-related end-stage liver disease. Similar to the first patient, rabeprazole sodium was discontinued upon the induction of SOF-LDV therapy. Eighteen days after SOF-LDV therapy induction, gastrointestinal endoscopy revealed the presence of a duodenal ulcer. In both cases, these duodenal ulcers improved after the resumption of the administration of PPIs, and a sustained virologic response at 12 weeks was achieved by SOF-LDV therapy with PPI use. Thus, PPI use should be continued consistently during SOF-LDV therapy for post-transplant HCV reinfection.
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Affiliation(s)
- S Miuma
- Department of Gastroenterology and Hepatology, Nagasaki University of Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - H Miyaaki
- Department of Gastroenterology and Hepatology, Nagasaki University of Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Y Miyazoe
- Department of Gastroenterology and Hepatology, Nagasaki University of Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Suehiro
- Department of Gastroenterology and Hepatology, Nagasaki University of Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - R Sasaki
- Department of Gastroenterology and Hepatology, Nagasaki University of Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - H Shibata
- Department of Gastroenterology and Hepatology, Nagasaki University of Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - N Taura
- Department of Gastroenterology and Hepatology, Nagasaki University of Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - K Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University of Graduate School of Biomedical Sciences, Nagasaki, Japan
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9
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Pereira MS, Wagner VP, Munerato MC, Clausell NO, Goldraich LA, Martins MAT, Martins MD, Carrard VC. Chronic painful oral ulcers in a heart transplant recipient. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:468-476. [PMID: 29555363 DOI: 10.1016/j.oooo.2018.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/20/2017] [Accepted: 01/02/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Manoela S Pereira
- Department of Oral Medicine, Porto Alegre Clinics Hospital (HCPA/UFRGS), Porto Alegre, RS, Brazil
| | - Vivian P Wagner
- Department of Oral Pathology, Dental School, Federal University of Rio do Sul, Porto Alegre, RS, Brazil
| | - Maria Cristina Munerato
- Department of Oral Medicine, Porto Alegre Clinics Hospital (HCPA/UFRGS), Porto Alegre, RS, Brazil
| | - Nadine O Clausell
- Post-Graduate Program in Cardiovascular Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Livia A Goldraich
- Heart Failure and Transplant Program, Porto Alegre Clinics Hospital (HCPA/UFRGS), Porto Alegre, RS, Brazil
| | - Marco Antonio T Martins
- Department of Oral Medicine, Porto Alegre Clinics Hospital (HCPA/UFRGS), Porto Alegre, RS, Brazil
| | - Manoela D Martins
- Department of Oral Medicine, Porto Alegre Clinics Hospital (HCPA/UFRGS), Porto Alegre, RS, Brazil; Department of Oral Pathology, Dental School, Federal University of Rio do Sul, Porto Alegre, RS, Brazil
| | - Vinicius C Carrard
- Department of Oral Medicine, Porto Alegre Clinics Hospital (HCPA/UFRGS), Porto Alegre, RS, Brazil; Department of Oral Pathology, Dental School, Federal University of Rio do Sul, Porto Alegre, RS, Brazil.
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10
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Candida is a protractive factor of chronic oral ulcers among usual outpatients. JAPANESE DENTAL SCIENCE REVIEW 2018; 54:52-58. [PMID: 29755615 PMCID: PMC5944075 DOI: 10.1016/j.jdsr.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 11/17/2017] [Accepted: 12/09/2017] [Indexed: 11/21/2022] Open
Abstract
Although many oral ulcers have similar clinical appearances, their etiologies can range from reactive to neoplastic to oral manifestations of dermatological diseases. In patients with an HIV infection, fungal diseases may cause ulceration in the oral cavity; however, there have been few studies of oral ulcerative lesions associated with Candida in patients without an HIV infection. Nevertheless, we encountered chronic oral ulcer associated with Candida among our frequent outpatients without an HIV infection. The present article reviews the causes of oral ulcers, focusing on Candida as a protractive factor for chronic oral ulcers, and it is recommended that Candida involvement be considered in diagnosis of a certain chronic oral ulcer, that remains of unknown origin even if some examinations have been performed.
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11
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Sonoda A, Wada K, Mizukami K, Fukuda K, Shuto M, Okamoto K, Ogawa R, Okimoto T, Murakami K. Deep Ulcers in the Ileum Associated with Mycophenolate Mofetil. Intern Med 2017; 56:2883-2886. [PMID: 28943566 PMCID: PMC5709631 DOI: 10.2169/internalmedicine.8815-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A 54-year-old man was treated with mycophenolate mofetil (MMF) after undergoing living donor renal transplantation. Two years later, he experienced repeated episodes of diarrhea, and his C-reactive protein (CRP) level was found to be 12.63 mg/dL. Ileocolonoscopy showed multiple deep, punched-out ulcers that were similar to Behçet's disease (BD) and cytomegalovirus (CMV) in the ileum. CMV infection was suspected. However, anti-cytomegalovirus agents were ineffective. The patient was subsequently diagnosed with gastrointestinal toxicity of MMF and MMF was switched to mizoribine. His symptoms improved immediately, and his CRP level normalized. Six months later, the patient's mucosa was healed.
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Affiliation(s)
- Akira Sonoda
- Department of Gastroenterology, Oita University, Japan
| | - Kurato Wada
- Department of Gastroenterology, Oita University, Japan
| | | | | | | | | | - Ryo Ogawa
- Department of Gastroenterology, Oita University, Japan
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12
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Ilyas M, Colegio OR, Kaplan B, Sharma A. Cutaneous Toxicities From Transplantation-Related Medications. Am J Transplant 2017; 17:2782-2789. [PMID: 28452165 DOI: 10.1111/ajt.14337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/22/2017] [Accepted: 04/22/2017] [Indexed: 01/25/2023]
Abstract
Despite the abundance of information on cutaneous malignancies associated with solid organ transplantation in the transplant literature, there is limited information regarding nonmalignant skin changes after transplantation. There are numerous skin toxicities secondary to immunosuppressive and other transplant-related medications that can vary in presentation, severity, and prognosis. To limit associated morbidity and mortality, solid organ transplant recipient care providers should effectively identify and manage cutaneous manifestations secondary to drug toxicity. Toxicities from the following transplant-related medications will be discussed: antithymocyte globulins, systemic steroids, cyclosporine, tacrolimus, azathioprine, mycophenolate mofetil, mammalian target of rapamycin inhibitors sirolimus and everolimus, basiliximab and daclizumab, belatacept, and voriconazole.
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Affiliation(s)
- M Ilyas
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ
| | - O R Colegio
- Departments of Dermatology, Pathology and Surgery, Yale University, New Haven, CT
| | - B Kaplan
- Department of Nephrology, Mayo Clinic Arizona, Scottsdale, AZ
| | - A Sharma
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ
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13
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Shamsuyarova A, Ghorab Z, Higgins K, Klieb H. Bilateral palatal ulcers in a patient on immunosuppressive therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 121:205-9. [PMID: 26460273 DOI: 10.1016/j.oooo.2015.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/31/2015] [Accepted: 08/15/2015] [Indexed: 11/19/2022]
Affiliation(s)
| | - Zeina Ghorab
- Department of Anatomic Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada
| | - Hagen Klieb
- Department of Anatomic Pathology and Department of Dentistry, University of Toronto, Toronto, Ontario, Canada
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14
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Salik J, Tang R, Nord K, Schneiderman PI, Grossman ME. Mycophenolate mofetil-induced oral ulcerations in solid organ transplant recipients: A report of 3 cases. JAAD Case Rep 2015; 1:261-3. [PMID: 27051747 PMCID: PMC4809219 DOI: 10.1016/j.jdcr.2015.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jonathan Salik
- Columbia University, College of Physicians and Surgeons, New York, New York
| | - Randy Tang
- Department of Dermatology, Columbia University, College of Physicians and Surgeons, New York, New York
| | - Kristin Nord
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Paul I Schneiderman
- Department of Dermatology, Columbia University, College of Physicians and Surgeons, New York, New York
| | - Marc E Grossman
- Department of Dermatology, Columbia University, College of Physicians and Surgeons, New York, New York
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15
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Philipone E, Rockafellow A, Sternberg R, Yoon A, Koslovsky D. Oral ulcerations as a sequela of tacrolimus and mycophenolate mofetil therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:e175-8. [DOI: 10.1016/j.oooo.2014.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/17/2014] [Accepted: 08/26/2014] [Indexed: 01/12/2023]
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16
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McNamara KK, Pugalagiri P. Clinicopathologic conference case 4: painful nonhealing oral ulcerations. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:e94-8. [PMID: 25295345 DOI: 10.1016/j.oooo.2014.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Adverse drug events in the oral cavity. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:35-47. [PMID: 25442252 DOI: 10.1016/j.oooo.2014.09.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/18/2014] [Accepted: 09/10/2014] [Indexed: 01/19/2023]
Abstract
Adverse reactions to medications are common and may have a variety of clinical presentations in the oral cavity. Targeted therapies and the new biologic agents have revolutionized the treatment of cancers, autoimmune diseases, and inflammatory and rheumatologic diseases but have also been associated with adverse events in the oral cavity. Some examples include osteonecrosis, seen with not only bisphosphonates but also antiangiogenic agents, and the distinctive ulcers caused by mammalian target of rapamycin inhibitors. As newer therapeutic agents are approved, it is likely that more adverse drug events will be encountered. This review describes the most common clinical presentations of oral mucosal reactions to medications, namely, xerostomia, lichenoid reactions, ulcers, bullous disorders, pigmentation, fibrovascular hyperplasia, white lesions, dysesthesia, osteonecrosis, infection, angioedema, and malignancy. Oral health care providers should be familiar with such events, as they will encounter them in their practice.
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18
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Integrity of the oral tissues in patients with solid-organ transplants. J Transplant 2012; 2012:603769. [PMID: 22363835 PMCID: PMC3272846 DOI: 10.1155/2012/603769] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/16/2011] [Accepted: 10/20/2011] [Indexed: 12/19/2022] Open
Abstract
The relationship between the use of immunosuppressants in solid-organ transplant patients and oral tissue abnormalities has been recognized. The objective of this study was to determine the state of oral tissue integrity in renal, heart, and liver transplant patients who are on continuous medical and dental control. Forty patients of both sexes were clinically evaluated at the Clinical Hospital of the University of Chile to identify pathologies of oral mucosa, gingival enlargement (GE), decayed, missing, filled teeth (DMFT) index, and salivary flow. The average age of the transplant subjects was 49.4 years, and the age range was 19 to 69 years. Most subjects maintained a good level of oral hygiene, and the rate mean of DMFT was 14.7. The degree of involvement of the oral mucosa and GE was low (10%). Unlike other studies, the frequency of oral mucosal diseases and GE was low despite the fact that these patients were immunosuppressed. Care and continuous monitoring seem to be of vital importance in maintaining the oral health of transplant patients.
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Weng RR, Foster CE, Hsieh LL, Patel PR. Oral ulcers associated with mycophenolate mofetil use in a renal transplant recipient. Am J Health Syst Pharm 2011; 68:585-8. [DOI: 10.2146/ajhp100276] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Renee R. Weng
- Department of Pharmacy Practice, Division of Renal and Pancreas Transplantation
| | | | - Lanny L. Hsieh
- Department of Medicine, University of California Irvine (UCI) Medical Center, Orange
| | - Puja R. Patel
- Northshore University Health System, Evanston, IL; at the time of writing she was a pharmacy student, UCI Medical Center
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Bertini F, Costa NCS, Brandão AAH, Cavalcante ASR, Almeida JD. Ulceration of the oral mucosa induced by antidepressant medication: a case report. J Med Case Rep 2009; 3:98. [PMID: 19946515 PMCID: PMC2783098 DOI: 10.1186/1752-1947-3-98] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 11/03/2009] [Indexed: 11/10/2022] Open
Abstract
Introduction Ulcers are frequent lesions of the oral mucosa. Generally, they are circumscribed round or elliptical lesions surrounded by an erythematous halo and covered with an inflammatory exudate in their central portion, and are accompanied by painful symptoms. Oral ulcers affect 20% of the population, especially adolescents and young adults. The etiopathogenesis includes immunological alterations, infections, nutritional deficiency, trauma, food and contact allergies, autoimmune diseases, neoplasms, and psychosomatic, genetic and environmental factors. Case presentation A 78-year-old Caucasian woman was referred by her dentist to our outpatient clinic with a 4-week history of an oral ulceration after using an antidepressant (sertraline hydrochloride). On the basis of the clinical findings and anamnesis, the occurrence of the lesion was attributed to the use of the drug. Exfoliative cytology was performed, to reassure the patient that it was not oral cancer, which revealed the presence of a nonspecific inflammatory reaction. The drug was replaced and resolution of symptoms was observed. Conclusion Exfoliative cytology should be the complementary examination of choice in cases of oral ulcers with a suspicion of drug interaction. Although this is a rare event in dental practice, dentists should be aware of the diagnostic possibility of drug-induced ulcers and should cooperate with the clinician to adjust the prescribed medication to resolve the symptoms.
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Muñoz-Corcuera M, Esparza-Gómez G, González-Moles MA, Bascones-Martínez A. Oral ulcers: clinical aspects. A tool for dermatologists. Part II. Chronic ulcers. Clin Exp Dermatol 2009; 34:456-61. [PMID: 19522982 DOI: 10.1111/j.1365-2230.2009.03219.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Oral ulcers are generally painful lesions that are related to various conditions developing within the oral cavity. They can be classified as acute or chronic according to their presentation and progression. Acute oral ulcers are be associated with conditions such as trauma, recurrent aphthous stomatitis, Behçet's disease, bacterial and viral infections, allergic reactions or adverse drug reactions. Chronic oral ulcers are associated with conditions such as oral lichen planus, pemphigus vulgaris, mucosal pemphigoid, lupus erythematosus, mycosis and some bacterial and parasitic diseases. The correct differential diagnosis is necessary to establish the appropriate treatment, taking into account all the possible causes of ulcers in the oral cavity. In this second part of this two-part review, chronic oral ulcers are reviewed.
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Affiliation(s)
- M Muñoz-Corcuera
- Stomatology Department, Dental School, Complutense University of Madrid, Madrid, Spain
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