Cyclosporin-Induced Gingival Enlargement in a Periodontitis Patient With Pemphigus Vulgaris: A Case Report.

Abstract

Background: Pemphigus vulgaris (PV) is a chronic autoimmune disorder affecting mucous membranes and skin, with potential life-threatening risks. It is typically characterized by blisters within the oral cavity with or without subsequent skin involvement. Given the importance of timely intervention, dental professionals are responsible for diagnosing this condition, as prompt detection and intervention greatly influence the disease progression and prognosis. Case Description: A 44-year-old male patient presented with swollen and bleeding gums, accompanied by multiple chronic ulcers in the oral cavity. He was initially diagnosed with PV in 2018; his case posed significant challenges, including drug-influenced gingival enlargement and the psychological burden of managing a chronic, relapsing condition. Management and Prognosis: The patient received treatment with an immunosuppressive medication (cyclosporin) along with long-term systemic steroids (prednisolone). In November 2022, cyclosporin was replaced with a steroid-sparing medication (methotrexate) to control drug-influenced gingival enlargement. The periodontal condition improved after 3 months of changing the medication regimen, nonsurgical periodontal therapy, and reinforced oral hygiene practices. The patient undergoes regular medical evaluations every 6 months with the dermatology department. Clinical Implications: Effective management of PV necessitates long-term systemic steroid therapy, often supplemented with immunosuppressive agents, to control the disease and minimize relapse risks. Regular clinical assessments are essential for patients receiving steroid and immunosuppressive treatment to monitor potential side effects, including cyclosporin-induced gingival enlargement. If gingival enlargement is compounded by periodontal disease, it can further complicate the management of PV. Drug-induced gingival enlargement has a favorable prognosis and is reversible upon discontinuation or substitution of the causative medication. An interdisciplinary approach involving primary clinicians, dentists, and the healthcare team is crucial to addressing the patient's signs and symptoms effectively.