Alhassan, Eaman MD∗; Al-Hassan, Lamees MSâ€
From the ∗Division of Rheumatology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
†College of Health Solutions, Arizona State University, Tempe, AZ.
The authors declare no conflict of interest.
Correspondence: Eaman Alhassan, MD, Division of Rheumatology, Department of Medicine, Room 423, IRD 4th Floor, 2020 Zonal Ave, Los Angeles, CA 90033. E-mail: [email protected].
A 66-year-old man with a history of an orthotopic heart transplant and rheumatoid arthritis presented to the clinic for a routine follow-up appointment. The patient reported swelling in his gums that started after his heart transplant surgery. He underwent gingival laser excision twice in the past, but the swelling recurred. Since his heart transplant surgery, he has taken daily tacrolimus, mycophenolic acid, and prednisone. Gingival hyperplasia (Figure, A) affecting the alignment of the teeth was notable on physical examination. His laboratory workup, including complete blood cell count, was within normal limits. The patient has had no cardiac complications since his surgery and chose to continue taking tacrolimus despite its adverse effect.
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FIGURE: A and B, Gingival hyperplasia affecting the alignment of the teeth.
Tacrolimus is an immunosuppressant used in organ transplants. It has been replacing cyclosporine as it showed it is associated with a lower prevalence and severity of gingival overgrowth.
Differential diagnosis:
- Vitamin C deficiency (scurvy)
- Gingival plaques
- Acute myeloid leukemia
- Peripheral giant cell granuloma
- Sarcoidosis
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