An Unusual Oral Chronic Graft-Versus-Host Disease-Like Syndrome Following a Liver Transplant

• Autores: Dr. Laurence Bunetel, François Le Gall, Yvonne Delaval, Jean-Louis Sixou, Alain Dabadie, Martine Bonnaure-Mallet
• Localización: Journal of periodontology, ISSN 0022-3492, Vol. 74, Nº. 4, 2003, págs. 552-556
• Idioma: inglés
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• Resumen

  • 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.