Rare case report of cyclosporine induced gingival hyperplasia

Suman Sethi and colleagues from the Department of Nephrology Dayanand Medical College and Hospital, Ludhiana, Punjab have recently studied an unusual case of cyclosporine induced gingival hyperplasia.

The study is published in the Journal of the Association of Physicians of India.

Drug-induced gingival overgrowth or enlargement manifests as abnormal growth of the gingiva due to an adverse drug reaction (ADR) in patients treated with anticonvulsants, immunosuppressants, and calcium channel blockers. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. It gradually becomes a source of pain and the condition often leads to disfiguration.

Researchers studied the case of a 28 year old male patient who was a known case of end stage renal disease on maintenance haemodialysis for last 1 year underwent live related renal transplant. The patient was on triple immunosuppression drugs (cyclosporine, MMF and glucocorticoids) for last 5 years and doing well on cyclosporine 75 mg twice daily, as the authors reported in their case report.

However, in the following years he presented with complaints of swelling of feet and breathlessness of 10 days duration. A thorough general clinical examination was carried out, suggestive of moderate pallor and pitting edema of feet.

Examination of oral cavity revealed significant gingival overgrowth in buccal mucosa of maxilla as well as mandible.

Furthermore, on lab evaluation his Hb was 8.8 g/dl, serum urea was 116 mg/dl and serum creatinine was 5.2 mg/dl. Serum cyclosporine level was 137 nmol/L (within therapeutic range). Renal graft biopsy was then done, suggestive of chronic allograft nephropathy.

Patient was not on medications like phenytoin or CCBs. The authors then made a final diagnosis of post renal transplant chronic allograft nephropathy with cyclosporine induced gingival hyperplasia.

Hence, the authors concluded that "gingival hyperplasia is a known complication of cyclosporine therapy and is more common in children and adolescents as compared to adults."

It can also be caused by drugs like phenytoin and CCBs. The degree of gingival hyperplasia is unrelated to the dose and levels of cyclosporine. Usually, the gingival overgrowth regresses after discontinuing the drug, they further added.