Thrush after anti-rejection treatments: What helps?

Hi @jbaggi 😊
It's very nice to meet you! I am a two year post kidney transplant patient. Which organ did you have transplanted and which meds were you give for your mild rejection treatments?
I thought I had thrush at one point, and my local nephrologist sent me to the ENT specialist for a culture. It turned out that it was not thrush and I was treated with OTC dry mouth drops, toothpaste, etc and it resolved. Was your thrush self-diagnosed or did you receive a doctor or culture that identified thrush?

I’ve had my kidney transplant for 6 years.
I self diagnosed the thrush, but I’ve had it before. I called the doc today to order a culture.
I went through two rounds of dexamethesone and a 180 mg. taper. Things were going good, labs looked good, did a routine DSA test and picked up the rejection.

Hi @jbaggi 😊
I am happy to hear that your doc ordered a culture to confirm if it's thrush or something else.
Maybe the culture will come back as "healthy flora" and the recommended treatment will be OTC products. These high dose meds can make your mouth feel and taste awful.
Regarding the rejection, was your routine DSA test done during one of your transplant anniversary visits to Mayo or did your local nephrologist order it? (I don't think I have ever had a DSA test). What does a DSA test measure?
I think I may request it during one of my future visits if it can help identify rejection.
I am very happy to hear you are celebrating your SIX year transplant anniversary and your kidney function tests are looking good...that's great news! It sounds like once your thrush (or mouth issue) is back under control you will be good to go again!
Another good point of getting the culture done is it will come back with both the diagnosis and the recommended med to treat whatever is identified, so you will have extra confidence that the med you take will resolve what you have. That may take away your worry that it feels like it's not resolving.
(Also, make sure to track your Tacronlimis blood levels while you are taking fluconazole, if you are currently taking Tacronlimis as one of your meds. I am pretty sure that Fluconazole can increase Tacronlimis blood levels).

I had Thrush once, and when I swallowed, it felt as if I was swallowing broken glass. Awful, and brings tears to my eyes just thinking about it!
As a transplant recipient, I am taking immunosuppressant meds. I also have an albuterol inhaler to control diagnosed Exercise-induced asthma.
My throat was sore after a long flight home, after a trip to high elevations in one of the National Parks where my husband and I spent days on the trail. I had incorrectly decided that my sore throat would go away after a few days of rest and hydration. MY 'self diagnosis' was wrong and as always happens, it was worse at night . So I went to the ER, where the nurse said that the cool dry air, the altitude, and the additional need for the inhaler while hiking had created a 'Perfect Storm' scenario for the thrush to develop. I was prescribed the Nystatin in the oral swish-in-mouth for 5 days. After 5 days I went to my PCP to get it checked, and he prescribed another 10 days. It went away, and have not had another incidence of it since.
I notified my transplant dept of the medication as soon as it was prescribed. I don't recall the incident having any effect on my labs.

Hi @jbaggi 😊
Good morning! I am checking in to see how you are feeling and if you had a culture? Are things improving a little on your current medication?
I hope you are starting to get some relief!

I had a culture which came back negative for yeast. I called my ENT doc and sent him some pictures. He diagnosed me with white tongue.
No real treatments other than sipping water, good oral hygiene etc. Doc said it can come and go.
Probably caused by my lupus and all the drugs I’ve been taking for my rejection episode. In addition I got Covid for the first time. Sure that didn’t help.
I have my 3rd kidney biopsy since June on the 30th of this month to see if the treatments worked.
Thanks to all of you for your helpful comments.

Hi @jbaggi 😊
I am so happy to hear the culture came back showing no thrush. White tongue is much easier to deal with and not as scary! Did you stop taking the fluconazole? Remember to test your Tacronlimis blood level next week after stopping (I am not sure if you take Tacronlimis). Nystatin swish has no effect on Tacronlimis blood levels, but oral fluconazole can raise Tac levels.
I forgot to ask you. How did they find your rejection? Were you having symptoms or kidney function numbers issue, or was it found during a protocol biopsy?
Thanks for sharing and very happy to receive your good news this morning!

They cut my tac in half when I was on fluconazole. I’ll get labs done later this week.
My rejection was detected during a routine donor specific antibody test. I then had a biopsy which showed some mild rejection. I then went through rejection treatments followed by a second biopsy. That biopsy still showed signs of rejection, but improved from the previous biopsy. I went through rejection treatments again which will be followed by a third biopsy the end of this month. Labs are looking pretty good.

@jbaggi
Happy to hear your team cut your Tac in half while you were taking fluconazole. Also, happy to hear that it's not thrush. I am very hopeful that your biopsy at the end of this month is now mild rejection free. Please post after you receive the news! What are your current meds and dosages? I am on 250mg bid Cellcept and 6mg Envarsus XR. My Cellcept is lowered because I am fighting the BK virus currently.

3mg tac per day
720 mg mycophenolate twice a day
10 mg prednisone
80 mg Bactrum
200 mg hydroxychloroquine per day for lupus