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An Unusual Oral Chronic Graft‐Versus‐Host Disease‐Like Syndrome Following a Liver Transplant
Author(s) -
Bunetel Laurence,
Le Gall François,
Delaval Yvonne,
Sixou JeanLouis,
Dabadie Alain,
BonnaureMallet Martine
Publication year - 2003
Publication title -
journal of periodontology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.036
H-Index - 156
eISSN - 1943-3670
pISSN - 0022-3492
DOI - 10.1902/jop.2003.74.4.552
Subject(s) - tacrolimus , medicine , graft versus host disease , liver transplantation , oral mucosa , hyperplasia , pathology , dermatology , pemphigus vulgaris , transplantation , disease , surgery
Background: Giving the immunosuppressive drug tacrolimus (FK506) to liver transplant patients has helped to considerably reduce oral side effects such as gingival hyperplasia. Patients taking cyclosporin who suffer from gingival hyperplasia are often switched to tacrolimus.Methods: We present here a pediatric liver transplantation case study. The patient has been followed for 5.5 years. She developed oral lesions that resulted in the immunosuppressive therapy being changed from tacrolimus to cyclosporin. In clinical terms, the atypical pathology consisted of hyperpigmented patches on the gingival margin, the internal surfaces of the cheeks, and the intraoral surfaces of the lips. When located on the lips, the hyperpigmented patches were associated with pruriginous and edematous lesions.Results: Optical and electronic microscopic examinations of a gingival tissue sample revealed the presence of melanin incontinence and lichenoid lesions with degenerated keratinocytes and a mild infiltrate of lymphocytes. This points to a chronic graft‐versushost disease (cGvHD)‐like syndrome linked to tacrolimus. This diagnosis was given further credence by improvement in the lesions following the switch to cyclosporin.Conclusion: To our knowledge, this is the first reported case of tacrolimus‐associated chronic GvHDlike syndrome occurring in the oral mucosa. J Periodontol 2003;74:552‐556.