Racca Francesca, Greco Jessica M, Tatakis Dimitris N
Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, Ohio, USA.
Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Clin Adv Periodontics. 2025 Jun 26. doi: 10.1002/cap.10369.
Drug-influenced gingival enlargement (DIGE) is a recognized adverse effect of certain medications, particularly immunosuppressants like cyclosporin and tacrolimus. However, there have been no documented cases of DIGE associated with voclosporin, a newer calcineurin inhibitor used primarily to treat lupus nephritis.
This report describes the case of a 27-year-old female with systemic lupus erythematosus and lupus nephritis who developed significant gingival enlargement within 2 months of initiating voclosporin therapy. The patient presented with generalized gingival swelling, spontaneous bleeding, and difficulty eating, leading to her referral to a periodontics clinic. Nonsurgical periodontal therapy was initially attempted, followed by a biopsy to confirm the diagnosis.
Despite nonsurgical interventions, the gingival enlargement persisted. Surgical therapy was offered but declined by the patient. Following interdisciplinary consultation, the voclosporin dosage was gradually reduced, and the drug was eventually discontinued. Marked clinical improvement was observed within 1 month after drug discontinuation, with reduced enlargement and diminished pain.
This case is the first to document gingival enlargement associated with voclosporin therapy. The findings emphasize the need for awareness of this potential adverse effect and highlight the importance of interdisciplinary care in managing such cases.
Voclosporin may cause gingival enlargement, similar to other calcineurin inhibitors, such as cyclosporin. With voclosporin emerging as a promising alternative for nephrologists in managing lupus nephritis, its prescription rates are likely to rise, which accentuates the importance of dental professionals being informed and vigilant about associated adverse effects on gingival tissues. Discontinuation of voclosporin should be considered, in consultation with the patient's medical team, if its oral adverse effects outweigh its therapeutic benefits, underscoring the significance of interdisciplinary cooperation and care.
The gingiva (gums) is often a site in the mouth where changes or reactions can occur in response to certain systemic medications. Some drugs, particularly those used to treat autoimmune conditions or following organ transplants, can cause the gums to grow excessively, a condition known as drug-induced gingival enlargement (also known as gingival overgrowth). In this report, we document the case of a 27-year-old woman with lupus nephritis who developed gingival enlargement after starting a medication called voclosporin. This drug is a newer treatment option for lupus nephritis, but until now had not been linked to gingival enlargement. The patient experienced significant gum swelling, bleeding, and pain, making it difficult for her to eat. After trying nonsurgical treatments with limited success, and given her objection to surgical therapy, the medication was gradually stopped in consultation with her physician. The enlargement of the gums significantly improved once the drug was discontinued. This report highlights for the first time, to the authors' knowledge, the development of gingival enlargement in response to voclosporin therapy and the significant improvement of the condition upon cessation of drug usage.
药物性牙龈增生（DIGE）是某些药物公认的不良反应，尤其是环孢素和他克莫司等免疫抑制剂。然而，尚无文献记载与voclosporin相关的DIGE病例，voclosporin是一种主要用于治疗狼疮性肾炎的新型钙调神经磷酸酶抑制剂。
本报告描述了一名27岁患有系统性红斑狼疮和狼疮性肾炎的女性病例，该患者在开始使用voclosporin治疗后2个月内出现明显的牙龈增生。患者出现广泛性牙龈肿胀、自发性出血和进食困难，因此被转诊至牙周病诊所。最初尝试了非手术牙周治疗，随后进行活检以确诊。
尽管进行了非手术干预，但牙龈增生持续存在。提供了手术治疗，但患者拒绝。经过多学科会诊，逐渐减少voclosporin剂量，最终停药。停药后1个月内观察到明显的临床改善，牙龈增生减轻，疼痛缓解。
本病例是首例记录与voclosporin治疗相关的牙龈增生病例。研究结果强调了认识这种潜在不良反应的必要性，并突出了多学科护理在处理此类病例中的重要性。
Voclosporin可能导致牙龈增生，类似于其他钙调神经磷酸酶抑制剂，如环孢素。随着voclosporin成为肾病学家治疗狼疮性肾炎的一种有前景的替代药物，其处方率可能会上升，这凸显了牙科专业人员了解并警惕其对牙龈组织相关不良反应的重要性。如果voclosporin的口腔不良反应超过其治疗益处，应与患者的医疗团队协商考虑停药，这强调了多学科合作与护理的重要性。
牙龈通常是口腔中因某些全身药物而发生变化或反应的部位。一些药物，特别是用于治疗自身免疫性疾病或器官移植后的药物，可导致牙龈过度生长，这种情况称为药物性牙龈增生（也称为牙龈过度生长）。在本报告中，我们记录了一名27岁狼疮性肾炎女性患者在开始使用一种名为voclosporin的药物后出现牙龈增生的病例。这种药物是狼疮性肾炎的一种新型治疗选择，但此前尚未与牙龈增生相关联。患者经历了明显的牙龈肿胀、出血和疼痛，导致进食困难。在尝试非手术治疗效果有限且患者拒绝手术治疗后，与她的医生协商后逐渐停用了该药物。停药后牙龈增生明显改善。据作者所知，本报告首次强调了voclosporin治疗引起的牙龈增生以及停药后病情的显著改善。
