Gingival changes in a drug-induced gingival overgrowth patient using tacrolimus: a case report

Year 2015, Volume: 5 Issue: 1, 75 - 79, 03.05.2015

Neslihan Nal Acar Leyla Kuru Ulku Noyan

Abstract

This case report presents a 33 year-old female renal transplant recipient who presented to our clinic with her chief complaint of gingival overgrowth. Following clinical and radiographic examinations, she was diagnosed with chronic periodontitis accompanied by cyclosporin A and nifedipine-induced gingival overgrowth. Initial periodontal therapy and replacement of cyclosporin A with tacrolimus, with continued nifedipine usage, were performed. Marked improvements in clinical parameters were observed within 3 months. Bilateral ulcerated lesions which were observed on attached gingiva of the upper and lower premolar regions 2 months after commencement of tacrolimus usage, were histopathologically examined and diagnosed with nonspecific ulcerations. These lesions disappeared within 2 months after the dose of tacrolimus was decreased. In this case report, a renal transplant patient with chronic periodontitis and gingival overgrowth was treated with scaling/root planning and conversion from cyclosporin A to tacrolimus. Ulcerations on the gingiva were assumed to have resulted from tacrolimus usage.

Keywords

Gingival overgrowth, cyclosporin A, tacrolimus

İlaca bağlı dişeti hiperplazisinde takrolimusa bağlı değişimler: Olgu raporu

Abstract

Bu vaka raporu, kliniğimize dişeti büyümesi şikayetiyle başvuran 33 yaşında, kadın, böbrek transplantasyon hastasını sunmaktadır. Klinik ve radyografik muayeneyi takiben, siklosporin A ve nifedipine bağlı dişeti hiperplazisinin eşlik ettiği kronik periodontitis teşhisi koyulmuştur. Başlangıç periodontal tedavinin yanında siklosporin A tacrolimusla değiştirilmiş, nifedipin kullanımına devam edilmiştir. 3 ayda klinik parametrelerde önemli gelişmeler görülmüştür. Tacrolimus kullanımından 2 ay sonra ortaya çıkan ve alt ve üst küçük azı bölgelerinde çift taraflı olarak gözlenen ülsere lezyonlar histopatolojik olarak incelenmiş ve spesifik olmayan ülserasyon olarak değerlendirilmiştir. Lezyonlar tacrolimus dozu azaltıldıktan 2 ay sonra kaybolmuştur. Bu vaka raporunda, kronik periodontitis ve dişeti hiperplazisi görülen böbrek transplantasyon hastası, diştaşı temizliği ve kök yüzeyi düzleştirmeyle birlikte siklosporinin tacrolimusla değiştirilmesiyle tedavi edilmiştir. Dişetindeki ülserasyonların tacrolimus kullanımından kaynaklanabileceği düşünülmüştür.

Keywords

Dişeti büyümesi, siklosporin A, takrolimus

References

• Prabhu A, Mehta DS. A morphologic comparison of gingival changes influenced by cyclosporin and tacrolimus in rats. J Periodontol. 2006; 77: 265-270.
• O’Valle F, Mesa F, Aneiros J, Gomez-Morales M, Lucena MA, Ramirez C. Gingival overgrowth induced by nifedipine and cyclosporin a. Clinical and morphometric study with image analysis. J Clin Periodontol. 1995; 22: 591-597.
• Pernu HE, Pernu LMH, Knuuttila MLE. Effect of periodontal treatment on gingival overgrowth among cyclosporin A treated renal transplant recipients. J Periodontol. 1993; 64: 1098-1100.
• Adams CKS, Famili P. A study of the effects of the drug FK506 on gingival tissues. Transplant Proceed. 1991; 23: 3193-3194.
• James JA, Jamal S, Hull PS, Macfarlane TV, Campbell BA, Johnson RWG et al. Tacrolimus is not associated with gingival overgrowth in renal transplant patients. J Clin Periodontol. 2001; 28: 848-852.
• Spolidorio LC, Spolidorio DM, Massucato EM, Neppelenbroek KH, Campanha NH, Sanches MH. Oral health in renal transplant recipients administered cyclosporin A or tacrolimus. Oral Dis. 2006; 12: 304-314.
• Asante-Korang A, Boyle GJ, Webber SA, Miller SA, Fricker FJ. Experience of FK506 immune suppression in pediatric heart transplantation: a study of long-term adverse effects. J Heart Lung Transplant. 1996; 15: 415-422.
• Silness J, Löe H. Periodontal disease in pregnancy. II-Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964; 22: 121-135.
• Seymour RA, Smith DG, Turnbull DN. The effects of phenytoin and sodium valproate on the periodontal health of adult epileptics patients. J Clin Periodontol. 1985; 12: 413-419.
• Seymour RA, Ellis JS, Thomanson JM. Risk factors for drug-induced gingival overgrowth. J Clin Periodontol. 2000; 27: 217-223.
• Aimetti M, Romano F, Debernardi C. Effectiveness of periodontal therapy on the severity of cyclosporin A-induced gingival overgrowth. J Clin Periodontol. 2005; 32: 846-850.
• Macario-Barrel A, Tanasescu S, Courville P, Redonnet M, Cordel N, Lauret P et al. Mouth ulcers in patients receiving tacrolimus. Ann Dermatol Venereol. 2001; 128: 1327-1329.
• Hernandez G, Jimenez C, Arriba L, Moreno E, Lucas M. Resolution of oral ulcerations after decreasing the dosage of tacrolimus in a liver transplantation recipient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 92: 526-531.
• Kolokotronis A, Doumas S. Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. Clin Microbiol Infect. 2006; 12: 202-211.