Pharmaco-induced lesions of the mouth in a patient after kidney transplantation: a clinical case

This article discusses pharmaco-induced lesions of the oral mucosa in patients after kidney transplantation based on a clinical observation. The relevance of the study is due to the need for long-term immunosuppressive therapy in transplant recipients, which significantly affects the condition of the oral tissues.

Special attention is paid to early diagnosis, analysis of clinical manifestations, and characterization of the course of pathological processes under immunosuppression.

A clinical case of a 64-year-old patient with stage 5 chronic kidney disease (hypertensive nephropathy, regular hemodialysis since 2021), kidney allograft, type 2 diabetes mellitus, multinodular goiter, and cholelithiasis is presented. The patient was hospitalized in the kidney transplant department for routine evaluation and treatment adjustment (successful kidney transplantation was performed in 2023). Examination revealed an increase in serum creatinine to 290 µmol/L. Hemodialysis was initiated and an arteriovenous fistula was created.

Oral examination revealed a dull, pale pink mucosa of the cheeks, palate, tongue, and alveolar ridges with signs of insufficient moisture. Teeth 2.5, 2.6, and 1.7 were retained roots with painless percussion; the simplified oral hygiene index was 1.6 (satisfactory hygiene); the DMFT index (decayed, missing, and filled permanent teeth) was 17 (high). Pronounced oral changes were noted, including xerostomia and multiple areas of tongue desquamation accompanied by pain, hyperemia, and fibrinous deposits. These changes developed six months after kidney allotransplantation and are presumably associated with the state of immunosuppression.

Based on the clinical observation, we illustrate the diagnostic difficulties caused by the polymorphic clinical picture and similarity of symptoms to other oral mucosal diseases.

We emphasize the need for an interdisciplinary approach to the management of this patient group with mandatory involvement of a dentist.

Dental adverse effects in patients after kidney transplantation increase the risk of infectious complications and require regular monitoring, meticulous oral hygiene, and comprehensive follow-up through interdisciplinary collaboration.