Nifedipine and mycophenolate mofetil-induced gingival hyperplasia in a patient with systemic sclerosis: Role of concomitant therapy and pharmacovigilance aspects

Abstract

Background

Drug-induced gingival overgrowth (DIGO) is a common adverse effect of anticonvulsants, calcium channel blockers (CCBs), and immunosuppressants like cyclosporine, with nifedipine being the most frequently implicated CCB. In contrast, mycophenolate mofetil (MMF)-induced DIGO is rare due to its antifibrotic properties.

Case report

We report a case of a 26-year-old female with systemic sclerosis (SSc), receiving nifedipine and MMF for Raynaud’s phenomenon and interstitial lung disease, who presented with grade I gingival hyperplasia confined to interdental papillae. Despite good oral hygiene, gingival inflammation, microstomia, and plaque accumulation contributed to DIGO. Nifedipine was substituted with tadalafil, and MMF was replaced with nintedanib due to worsening interstitial lung disease. The pathogenesis of DIGO involves TGF-β-mediated fibroblast proliferation and extracellular matrix deposition, mechanisms also implicated in SSc-related fibrosis. Genetic polymorphisms in TGF-β and fibroblast regulatory genes further increase susceptibility. Effective management includes drug substitution, meticulous oral hygiene, and surgical excision for persistent cases.

Conclusion

This report highlights the need for vigilant pharmacovigilance in SSc patients, emphasizing early detection, genetic risk assessment, and preventive dental care to mitigate DIGO progression. Personalized risk stratification based on genetic profiling may enhance DIGO prevention and therapeutic strategies in high-risk individuals.