Mycophenolate mofetil (MMF) is a potent immunosuppressive agent frequently used to prevent acute graft rejection in kidney transplant recipient. It has various adverse effects such as leukopenia, anemia, and diarrhea. However, oral ulcers are rarely reported. We present a case of a living-donor kidney transplant recipient who developed multiple oral ulcers during high dose MMF therapy. A 24-year-old female with end-stage renal failure due to lupus nephritis underwent kidney transplantation from a CMV-positive living donor in August 2021 complained of painful oral ulcers which developed 2 months after kidney transplantation. As the ulcers grew larger and more painful, the patient began to have odynophagia and symptoms worsened. The immunosuppressive maintenance regimen comprised of steroid, tacrolimus and MMF. At the beginning, the internist suspected that the oral ulcers were caused by CMV infection. Despite the use of valgancyclovir for 4 months, the oral ulcers persisted and showed no improvement. On physical examination, multiple deep and large ulcers on the gingiva, buccal and labial mucosa were noted. The ulcers characteristics, minimal response to valgancyclovir therapy, and the absence of other infection possibly caused oral ulcers led the oral medicine specialist to the diagnosis of high dose MMF-induced oral ulcers. MMF was replaced with enteric-coated mycophenolate sodium at lower dose and the patient was instructed to use dexamethason swish and spit thrice a day, oral ulcers showed improvement after 5 days. Oral ulcers in kidney transplant patients should be carefully evaluated, and if MMF is suspected as the cause, MMF should be reduced or another therapeutic option is considered.

• kidney transplantation,
• immunosuppressive agents,
• mycophenolate mofetil,
• oral ulcer

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