Rare case of Sitagliptin-Induced Oral ulceration

Background:

There is a spectrum of adverse drug reactions in the oral cavity, ranging from drug-induced xerostomia to the development of severe mucosal disorders including extensive ulceration and mucositis. In relation to drug-induced ulcerations, there are previously established adverse effects of some medications such as nicorandril and low dose methotrexate. There are however, limited reports on the effects of DD4 Inhibitors (Gliptins) on the oral cavity. This case details our encounter of a Sitagliptin – induced ulcerated lesion on the lateral border of the tongue.

Case:

An 87 YO male was referred by his doctor to our clinic with a persistent ulcer of 6 weeks on the lateral border of the tongue. Examination revealed a flat, soft, painful ulcer on the lateral border of the tongue with a fibrinous base and white “halo” margin. There was no evidence of trauma.

Assessing the patient’s drug history we noted that he was commenced on sitagliptin for management of his Diabetes mellitus 4 months prior to the development of the lesion. This was the only change in medications for a year. A literature search revealed 4 reports of gliptin induced oral ulceration. Haematinic investigations also revealed a diagnosis of iron deficiency anaemia. After liaising with his GMP, the sitagliptin was stopped and the patient was investigated and treated for iron deficiency anaemia which was likely related to his CKD. A review 4 weeks after omitting the sitagliptin demonstrated complete resolution of the ulcer. The outcome for our patient supports the diagnosis of a sitagliptin- induced ulcer compounded by his anaemia.

Oral ulceration or mucosal changes are not mentioned in the British National Formulary as a recognised side effect of sitagliptin or other gliptins. This case report will promote awareness to our colleagues about the possible oral implications of gliptin therapy.