[Mouth ulcers in patients receiving tacrolimus]

Area of Science:

• Immunology
• Pharmacology
• Oral Medicine

Background:

• Buccal side effects of immunosuppressants like cyclosporine are documented.
• Tacrolimus is a novel immunosuppressive macrolide used in organ transplantation.
• This study investigates a rare buccal complication associated with tacrolimus therapy.

Observation:

• A heart transplant recipient developed painful, aphthoid buccal ulcerations eight months after initiating tacrolimus.
• Extensive investigations ruled out other common etiologies for the ulcerations.
• Treatment with thalidomide was initiated but led to adverse events and rapid relapse of ulcerations upon its suspension.

Findings:

• The ulcerations presented with an anatomo-clinical profile distinct from typical aphthous ulcers.
• The temporal relationship and relapse patterns strongly implicated tacrolimus as the causative agent.
• The observed ulcerations shared similarities with those induced by nicorandil.

Implications:

• This case suggests tacrolimus may induce specific buccal ulcerations, necessitating careful monitoring in patients.
• Clinicians should consider tacrolimus-induced toxicity when evaluating unexplained oral lesions in immunosuppressed patients.
• Further research is warranted to elucidate the mechanism of tacrolimus-related oral toxicity.