Cas clinique
Ulcérations buccales après prise de mycophénolate de sodium (Myfortic®)

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Résumé

Introduction

Le mycophénolate de sodium (Myfortic®) est une formulation gastrorésistante de l’acide mycophénolique utilisé comme agent immunosuppresseur. Nous rapportons le cas d’une femme ayant eu des ulcérations buccales multiples associées à la prise de mycophénolate de sodium avec récidive des ulcérations lors de la réintroduction de ce traitement.

Observation

Il s’agissait d’une femme de 26 ans suivie depuis 1993 pour un lupus érythémateux disséminé, traité initialement par corticothérapie et mycophénolate mofétil (Cellcept®). Ce traitement avait été arrêté en raison de la survenue d’un zona plurimétamérique et d’une leucopénie. Elle consultait pour des ulcérations buccales invalidantes survenues 15 jours après l’introduction d’un traitement par mycophénolate de sodium. Il n’y avait aucun argument pour une infection opportuniste ou une poussée lupique. L’arrêt du médicament permettait une disparition des lésions. La réintroduction de mycophénolate de sodium quelques semaines plus tard entraînait une récidive des ulcérations buccales, régressant 72 heures après l’arrêt définitif du médicament.

Discussion

Le mycophénolate de sodium est une formulation récente, gastrorésistante de l’acide mycophénolique, développée pour réduire les effets indésirables digestifs du mycophénolate mofétil. Des cas isolés d’ulcérations buccales après prise de mycophénolate mofétil ont été rapportés. Une toxicité directe du médicament était alors évoquée. Cet effet indésirable n’avait jamais été décrit avec le mycophénolate de sodium. Dans notre observation, le fait que la malade avait préalablement pris un traitement par mycophénolate mofétil, sans toxicité muqueuse, alors qu’elle était exposée à une concentration en acide mycophénolique au moins équivalente, est d’autant plus particulier.

Summary

Background

Mycophenolate sodium (Myfortic®) is an enteric-coated formulation of the immunosuppressant therapy mycophenolic acid. We report a case of diffuse mouth ulceration in a patient treated with Myfortic® presenting recurrence after another dose of drug.

Patients and methods

We report the case of a 26-year-old female patient with systemic lupus erythematosus, initially treated with corticosteroids and mycophenolate mofetil, but which was stopped because of varicella-zoster dissemination and leucopoenia. She consulted for mouth ulcers occurring two weeks after the introduction of Myfortic®. There were no signs of opportunist infection or lupus activity. Mucosal ulcerations disappeared when Myfortic® was stopped. Several weeks later, the patient presented recurrence of mouth ulcerations after another treatment of Myfortic®.

Discussion

Myfortic® is a new enteric-coated formulation of mycophenolic acid developed to reduce gastrointestinal upset associated with Cellcept®. In certain cases, Cellcept® toxicity can present as a number of oral ulcerations. Direct toxicity is involved in these cases. This side effect has never been described with Myfortic®. In our case, the distinctive characteristic is that the patient was never treated with Cellcept® without mucosal toxicity despite equivalent systemic mycophenolic acid exposure.

Références (16)

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