# Epstein-Barr Virus-Positive Mucosal Skin Ulcer Resulting in Oral Lesions During Concomitant Use of Tacrolimus and Prednisolone

## TL;DR

A 63-year-old man developed an Epstein-Barr virus-related skin ulcer in his mouth while on two immunosuppressive drugs, and stopping one drug led to recovery.

## Contribution

This case suggests that switching to monotherapy may be an effective treatment for Epstein-Barr virus-positive mucocutaneous ulcers.

## Key findings

- The patient's EBVMCU resolved after discontinuing tacrolimus and switching to prednisolone monotherapy.
- The lesion showed improvement within two months following the drug adjustment.
- The case supports monotherapy as a potential treatment strategy for EBVMCU.

## Abstract

Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) is a subtype of Epstein-Barr virus-positive lymphoproliferative disease with a favorable prognosis that can develop either due to medical interventions or as a consequence of aging. Medical-onset cases caused by immunosuppressive drugs may require a reduction or discontinuation of the causative drugs. However, specific methods for drug adjustment in cases where multiple immunosuppressive drugs are used have not yet been established. Herein, we present the case of a 63-year-old man with interstitial pneumonia who developed an EBVMCU on the right side of his tongue. He was on multidrug therapy with tacrolimus and prednisolone and was treated conservatively by discontinuation of the tacrolimus and switching to prednisolone monotherapy. The lesion resolved within two months following the adjustment. This case report provides evidence that conversion to monotherapy, rather than multiple immunosuppressive drugs, is a potentially effective treatment option for EBVMCU.