Abstract: FR-PO1022
Tacrolimus-Associated Oral and Genital Ulcers and Terminal Ileitis After Kidney Transplantation, Mimicking Behçet Syndrome
Session Information
- Transplantation: Clinical - Pharmacology and Nonkidney Solid Organ Transplants
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Muñoz Montes de Oca, Diana Laura, Centro Medico Nacional del Occidente, Guadalajara, Jal., Mexico
- Alcala, José Gilberto, Centro Medico Nacional del Occidente, Guadalajara, Jal., Mexico
- Cruz Landino, Moises, Centro Medico Nacional del Occidente, Guadalajara, Jal., Mexico
- Santisbais Beas, Maria del Refugio, Centro Medico Nacional del Occidente, Guadalajara, Jal., Mexico
- Parra Guerra, Ricardo, Centro Medico Nacional del Occidente, Guadalajara, Jal., Mexico
- Banda Lopez, Adriana, Centro Medico Nacional del Occidente, Guadalajara, Jal., Mexico
Group or Team Name
- Departamento de Nefrologia y Trasplante, Centro Médico Nacional de Occidente, IMSS, Guadalajara Jalisco.
Introduction
Immunosuppressive agents have revolutionized the field of transplantation; their use is often associated with a wide range of adverse effects. We present the case of a kidney transplant (KT) recipient who developed painful oral and genital ulcers along with terminal ileitis, a rare constellation of findings mimicking Behçet syndrome.
Case Description
A 36-year-old woman underwent deceased donor KT six months prior. She presented with painful, punched-out oral and genital ulcers that impaired oral intake. Diagnostic workup included bacterial, fungal, and mycobacterial cultures, PCR testing for cytomegalovirus (CMV), adenovirus, and Epstein–Barr virus—all of which were negative. Biopsy of oral lesions showed severe acute inflammation, necrosis, and hemorrhage. Tests revealed: CRP 51.4 mg/dL, ESR 32 mm/h, negative autoimmune markers, and supratherapeutic tacrolimus (TAC) levels 14.6 ng/mL. TAC was reduced by 50% and mycophenolate mofetil was discontinued. Two weeks later, she developed lower gastrointestinal bleeding. Colonoscopy revealed 50% stenosis and multiple 8–10mm ulcers in terminal ileum. Histology showed necrotizing vasculitis of small/medium vessels; CMV was negative. TAC was replaced with cyclosporine, prednisone up to 50 mg daily and azathioprine 50 mg BID, achieving clinical remission.
Discussion
There are few reports of concurrent oral and genital ulceration with ileitis following KT. Supratherapeutic TAC levels have been implicated in syndromes mimicking Behçet disease. Although rare, prompt recognition and adjustment of the offending agent can prevent significant morbidity. This case highlights the importance of considering TAC toxicity in the differential diagnosis of mucocutaneous and gastrointestinal ulcerations in KT