Victory Rodríguez G, Ruiz Gutiérrez ADC, Gómez Sandoval JR, Lomelí Martínez SM. Gingival enlargement induced by cyclosporine in Medullary aplasia: A case report. World J Clin Cases 2022; 10(34): 12750-12760 [PMID: 36579122 DOI: 10.12998/wjcc.v10.i34.12750]
Corresponding Author of This Article
Sarah Monserrat Lomelí Martínez, Doctor, Academic Research, Associate Research Scientist, Department of Medical and Life Sciences, Centro Universitario de la Ciénega, Universidad de Guadalajara, Universidad No. 1115, Lindavista, Ocotlán 47810, Jalisco, Mexico. sarah.lomeli@academicos.udg.mx
Research Domain of This Article
Dentistry, Oral Surgery & Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 6, 2022; 10(34): 12750-12760 Published online Dec 6, 2022. doi: 10.12998/wjcc.v10.i34.12750
Gingival enlargement induced by cyclosporine in Medullary aplasia: A case report
Giovanna Victory Rodríguez, Alondra del Carmen Ruiz Gutiérrez, Juan Ramón Gómez Sandoval, Sarah Monserrat Lomelí Martínez
Giovanna Victory Rodríguez, Alondra del Carmen Ruiz Gutiérrez, Periodontics Program, Department of Integrated Dentistry Clinics, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
Juan Ramón Gómez Sandoval, Research Institute of Dentistry, Department of Integrated Dentistry Clinics, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco , Mexico
Sarah Monserrat Lomelí Martínez, Department of Medical and Life Sciences, Centro Universitario de la Ciénega, Universidad de Guadalajara, Ocotlán 47810, Jalisco, Mexico
Author contributions: Victory Rodríguez G, Ruiz Gutiérrez ADC and Lomelí Martínez SM contributed to diagnosis, surgical treatment and manage of patient; Lomelí Martínez SM and Victory Rodríguez G contributed to acquisition and analysis of data; Ruiz Gutiérrez ADC and Gómez Sandoval JR drafted manuscript and critically revised manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sarah Monserrat Lomelí Martínez, Doctor, Academic Research, Associate Research Scientist, Department of Medical and Life Sciences, Centro Universitario de la Ciénega, Universidad de Guadalajara, Universidad No. 1115, Lindavista, Ocotlán 47810, Jalisco, Mexico. sarah.lomeli@academicos.udg.mx
Received: September 11, 2022 Peer-review started: September 11, 2022 First decision: September 26, 2022 Revised: October 8, 2022 Accepted: November 8, 2022 Article in press: November 8, 2022 Published online: December 6, 2022 Processing time: 81 Days and 22.7 Hours
Abstract
BACKGROUND
Cyclosporine is an immunosuppressive agent used effectively for treatment of a rare haematological disorder known as medullary aplasia. This drug prevents several side effects, including gingival enlargement (GE) which compromises aesthetics, phonetics and chewing, and also predisposes patients to periodontitis.
CASE SUMMARY
This clinical case reports a 41-year-old woman who presented with cyclosporine-induced GE with underlying periodontitis and medullary aplasia. The management of the disease was approached through multidisciplinary strategy which allowed for accurate diagnosis and a strategic treatment based on the systemic condition and severity of oral pathology. The diagnosis was confirmed through histopathological analysis. The treatment was carried out in phases: Initial (oral hygiene motivation, mechanical supragingival plaque control, and non-surgical therapy); systemic treatment, corrective treatment, and maintenance.
CONCLUSION
Multidisciplinary management of cyclosporine-induced GE and medullary aplasia allows for correct diagnosis and effective treatment of this pathological expression through a phased therapeutic approach.
Core Tip: Medullary aplasia is a marrow failure characterized by a total or partial disappearance of hematopoietic precursors in bone marrow, resulting in pancytopenia which is usually accompanied by hemorrhagic syndrome. The treatment involves immunosuppressive therapy with cyclosporine. This drug suppresses the activity of immune cells that damage the bone marrow, although it may produce an inflammatory reaction, with increased fibrotic response in the extracellular matrix, and gingival enlargement (GE). We report a case of GE induced by cyclosporine in a patient with rare medullary aplasia, which was managed with a phased periodontal treatment plan.
