EXTENSIVE ULCERATIONS ASSOCIATED WITH THE USE OF MYCOPHENOLATE MOFETIL IN A PATIENT WITH HISTORY OF RENAL TRANSPLANT

A 54-year-old white female patient presented with bilateral angular cheilitis and several painful ulcerated oral lesions, 11 years after kidney transplantation. The lesions affected the buccal mucosa, the soft palate, and dorsum of the tongue for 8 months. Her current immunosuppressive regimen includes mycophenolate mofetil, tacrolimus, and prednisone. Periodic acid-Schiff (PAS) exfoliative cytology was positive for Candida species. An incisional biopsy was performed on the tongue lesion and the histopathologic examination revealed intense mixed inflammatory infiltrate in the connective tissue. Serologic tests excluded cytomegalovirus and herpes simplex infection. Thus, the diagnosis of oral candidiasis and ulcers associated with mycophenolate mofetil was established. Local therapy with antifungal and corticosteroid agents healed the lesions in buccal mucosa and soft palate. The tongue lesion did not respond to therapy. Buccal mucosa lesions recurred after a follow-up period of 1 month. The patient was referred to the nephrologist to evaluate for the possibility of changing the immunosuppressive therapeutic regimen.