CASE REPORT: MANAGEMENT OF ORAL LESIONS ASSOCIATED WITH IMMUNOSUPPRESSANTS IN A PEDIATRIC KIDNEY TRANSPLANT RECIPIENT

Abstract

Introduction: Kidney transplantation is a well-established treatment for pediatric patients with chronic kidney disease; however, continuous immunosuppressive therapy is required to prevent graft rejection. Oral manifestations such as ulcerative lesions are among the systemic side effects these medications may cause.

Objective: To report the therapeutic management of oral lesions in a pediatric kidney transplant recipient undergoing immunosuppressive therapy with sirolimus.

Case report: A 6-year-old male patient presented to a referral hospital in Fortaleza, Brazil, with multiple painful oral lesions characterized by whitish bases and erythematous borders on the buccal mucosa and upper lip. The lesions caused irritability and odynophagia, with no improvement after treatment with topical triamcinolone and nystatin. Six sessions of low-level light therapy (LLLT) were performed: three initial sessions with 3 J visible and 3 J infrared, followed by three sessions with 1 J visible and 3 J infrared, applied to the upper lip and retromolar area. The immunosuppressive regimen was adjusted in collaboration with the medical team, switching the medication to tacrolimus. Eating, speaking, and oral hygiene improved following significant regression of the lesions and a marked reduction in pain.

Conclusion: The combination of photobiomodulation therapy and modulation of the immunosuppressive regimen proved effective in accelerating healing, reducing discomfort, and improving quality of life.