Surgical Management of Severe Drug-Induced Gingival Hypertrophy: A Case Report

Gingival enlargement is an adverse effect of certain medications, most notably calcium channel blockers, immunosuppressants, and anticonvulsants. We report the case of a 15-year-old male with end-stage renal disease who developed severe drug-induced gingival enlargement (DIGE) following a deceased donor renal transplant. His immunosuppressive regimen included tacrolimus, prednisone, mycophenolate mofetil, and thymoglobulin, later supplemented with nifedipine for hypertension. Three years after transplant, he developed progressively severe gingival enlargement, leading to impaired mastication, weight loss, and symptoms of sleep-disordered breathing. Examination revealed marked maxillary and mandibular hyperplasia with pedunculated lesions and enlarged tonsils. Imaging confirmed vascular gingival lesions without bony involvement. The patient underwent operative debulking of the gingival tissue using a Gigli saw and scissors, with adjunctive hemostatic measures, as well as tonsillectomy. Histopathology confirmed fibromatosis with chronic inflammation consistent with DIGE. Postoperatively, the patient demonstrated significant clinical improvement, with weight gain, restoration of oral intake, and satisfactory gingival healing at 3 weeks. This case highlights the complex interplay between immunosuppressants, calcium channel blockers, and oral health in pediatric transplant recipients. Although minor DIGE may regress with medication adjustment and improved oral hygiene, severe cases often necessitate surgical management. Early recognition, interdisciplinary collaboration, and timely surgical intervention are essential to restore function and quality of life in affected patients, particularly those who are immunosuppressed.