Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2016.041
Autopsy and Case Reports
Article / Clinical Case Report

Amlodipine-induced gingival overgrowth in a child after liver transplant

André Guollo, Ana Paula Molina Vivas, Rodrigo Nascimento Lopes, Gilda Porta, Fábio Abreu Alves

Downloads: 28
Views: 797

Abstract

Drug-induced gingival overgrowth (GO) has been associated with phenytoin, cyclosporine, and calcium channel blocker therapies. This study reports the case of an 11-year-old girl who was referred for evaluation of GO, which had occurred over the last 6 months. Her medical history included a liver transplant due to biliary atresia 3 years ago, immunosuppressive therapy, and hypertension, which is why she was started on a daily intake of amlodipine. The intraoral examination showed generalized GO, and the treatment consisted of a gingivectomy. Subsequently, amlodipine was replaced with captopril and oral hygiene instructions. There was no recurrence of GO after 28 months of follow-up. Although GO may be related to the chronic use of amlodipine, such an association is uncommon in pediatrics, and the treatment consists of the replacement of medication combined with a surgical approach and plaque control.

Keywords

Amlodipine, Gingival Overgrowth, Liver Transplantation

References

1. Martin SR, Atkison P, Anand R, Lindblad AS. Studies of pediatric liver transplantation 2002: patient and graft survival and rejection in pediatric recipients of a first liver transplant in the United States and Canada. Pediatr Transplant. 2004;8(3):273-83. http://dx.doi.org/10.1111/j.1399-3046.2004.00152.x. PMid:15176966.

2. Tannuri U, Velhote MCP, Santos MM, et al. Pediatric liver transplantation: fourteen years of experience at the children Institute in São Paulo, Brazil. Transplant Proc. 2004;36(4):941-2. http://dx.doi.org/10.1016/j.transproceed.2004.03.101. PMid:15194325.

3. McDiarmid SV, Anand R, Lindblad AS. Studies of pediatric liver transplantation: 2002 update. An overview of demographics, indications, timing, and immunosuppressive practices in pediatric liver transplantation in the United States and Canada. Pediatr Transplant. 2004;8(3):284-94. http://dx.doi.org/10.1111/j.1399-3046.2004.00153.x. PMid:15176967.

4. Spada M, Riva S, Maggiore G, Cintorino D, Gridelli B. Pediatric liver transplantation. World J Gastroenterol. 2009;15(6):648-74. http://dx.doi.org/10.3748/wjg.15.648. PMid:19222089.

5. Galioto A, Semplicini A, Zanus G, et al. Nifedipine versus carvedilol in the treatment of de novo arterial hypertension after liver transplantation: results of a controlled clinical trial. Liver Transpl. 2008;14(7):1020-8. http://dx.doi.org/10.1002/lt.21442. PMid:18581464.

6. Carbone M, Sagar V, Ferguson J, Neuberger J. Calcium channel blockers or angiotensin-converting enzyme inhibitors for de novo hypertension after liver transplant: and the winner is …? Transplantation. 2012;93(2):2-4. http://dx.doi.org/10.1097/TP.0b013e31823c6811. PMid:22234315.

7. Algarem N, Sholkamy A, Alshazly M, Daoud A. Newonset diabetes and hypertension as complications of liver transplantation. Transplant Proc. 2014;46(3):870-2. http://dx.doi.org/10.1016/j.transproceed.2013.12.007. PMid:24767368.

8. Lai HM, Pawar R, Wolf DC, Aronow WS. Impact of cardiovascular risk factors on long-term mortality after liver transplantation. Am J Ther. 2014. PMid:24897624.

9. Ellis J, Seymour RA, Thomason JM, Monkman SC, Idle JR. Gingival sequestration of amlodipine and amlodipine-induced gingival overgrowth. Lancet. 1993;341(8852):1102-3. http://dx.doi.org/10.1016/0140-6736(93)92470-E. PMid:8097007.

10. Srivastava AK, Kundu D, Bandyopadhyay P, Pal AK. Management of amlodipine-induced gingival enlargement: Series of three cases.J Indian Soc Periodontol. 2010;14(4):279-81. http://dx.doi.org/10.4103/0972-124X.76931. PMid:21731258.

11. TejnaniA, ManiA, SodhiNK, et al. Incidence of amlodipineinduced gingival overgrowth in the rural population of Loni. J Indian Soc Periodontol. 2014;18(2):226-8. http://dx.doi.org/10.4103/0972-124X.131332. PMid:24872633.

12. Sucu M, Yuce M, Davutoglu V. Amlodipine-induced massive gingival hypertrophy. Can Fam Physician. 2011;57(4):436-7. PMid:21490356.

13. Vivas AP, Bomfin LE, Costa WL Jr, Porta G, Alves FA. Oral granulomatosis-like lesions in liver-transplanted pediatric patients. Oral Dis. 2014;20(3):97-102. http://dx.doi.org/10.1111/odi.12143. PMid:23781921.

14. Brown R, Arany P. Mechanism of drug-induced gingival overgrowth revisited: a unifying hypothesis. Oral Dis. 2015;21(1):51-61. http://dx.doi.org/10.1111/odi.12264. PMid:24893951.

15. Textor SC, Taler SJ, Canzanello VJ, Schwartz L, Augustine JE. Posttransplantation hypertension related to calcineurin inhibitors. Liver Transpl. 2000;6(5):521-30. http://dx.doi.org/10.1053/jlts.2000.9737. PMid:10980050.

16. Jorgensen MG. Prevalence of amlodipine-related gingival hyperplasia. J Periodontol. 1997;68(7):676-8. http://dx.doi.org/10.1902/jop.1997.68.7.676. PMid:9249639.

17. Ono M, Tanaka S, Takeuchi R, et al. Prevalence of amlodipine-induced gingival overgrowth. Int J OralMed Sci. 2010;9(2):96-100. http://dx.doi.org/10.5466/ijoms.9.96.

18. Helenius-Hietala J, Ruokonen H, Grönroos L, et al. Oral mucosal health in liver transplant recipients and controls. Liver Transpl. 2014;20(1):72-80. http://dx.doi.org/10.1002/lt.23778. PMid:24142471.

19. Shiboski CH, Krishnan S, Besten PD, et al. Gingival enlargement in pediatric organ transplant recipients in relation to tacrolimus-based immunosuppressive regimens. Pediatr Dent. 2009;31(1):38-46. PMid:19320258.

20. James JA, Jamal S, Hull PS, et al. Tacrolimus is not associated with gingival overgrowth in renal transplant patients. J Clin Periodontol. 2001;28(9):848-52. http://dx.doi.org/10.1034/j.1600-051x.2001.028009848.x. PMid:11493354.

21. Greenberg KV, Armitage GC, Shiboski CH. Gingival enlargement among renal transplant recipients in the era of new-generation immunosuppressants. J Periodontol. 2008;79(3):453-60. http://dx.doi.org/10.1902/jop.2008.070434. PMid:18315427.

22. Cezário ES, Cota LO, Ferreira SD, et al. Gingival overgrowth in renal transplant subjects medicated with tacrolimus in the absence of calcium channel blockers. Transplantation. 2008;85(2):232-6. http://dx.doi.org/10.1097/TP.0b013e3181604fad. PMid:18212628.

23. Paixao CG, Sekiguchi RT, Saraiva L, et al. Gingival overgrowth among patients medicated with cyclosporin A and tacrolimus undergoing renal transplantation: a prospective study. J Periodontol. 2011;82(2):251-8. http://dx.doi.org/10.1902/jop.2010.100368. PMid:20722530.

24. Grover V, Kapoor A, Marya CM. Amlodipine induced gingival hyperplasia. J Oral Health Comm Dent. 2007;1(1):19-22.


Publication date:
09/29/2016

57ed539a0e8825114adbebfd autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections