Correspondence
Improvement in Cyclosporine-Associated Gingival Hyperplasia with Azithromycin Therapy
N Engl J Med 1995; 332:753-754March 16, 1995
- Article
To the Editor:
Gingival hyperplasia is a known complication of cyclosporine therapy. It appears to be worsened by the concomitant administration of nifedipine or phenytoin.
Two transplant recipients had dramatic improvements in symptomatic gingival hyperplasia after a short course of azithromycin. The first patient was a 49-year-old man with chronic glomerulonephritis who received a cadaveric renal transplant on September 16, 1987. He received immunosuppressive therapy with corticosteroids, azathioprine, and cyclosporine. An early episode of rejection was treated with intravenous methylprednisolone. Gingival hyperplasia was noted on June 6, 1989. In September 1992, a further increase in the gingival tissue was noted. In December 1993, an episode of bronchitis was treated with azithromycin (an initial dose of 500 mg, followed by a daily dose of 250 mg for four days). Concurrent medications included cyclosporine, azathioprine, prednisone, aspirin, furosemide, simvastatin, verapamil, trimethoprim–sulfamethoxazole, and folic acid. During a routine office visit in March 1994, the patient stated that the gingival bleeding had totally resolved and that the gum hyperplasia had regressed. Physical examination showed mild plaque and no gingival hyperplasia or erythema.
The second patient, a 41-year-old woman who had had Wegener's granulomatosis since 1978, received a kidney from a living related donor on May 22, 1990. The immunosuppressive regimen included corticosteroids, cyclosporine, and azathioprine. An early episode of rejection in July 1992 was treated with a course of oral prednisone. A second episode of rejection occurred on September 3, 1993, after an attempt to use an alternate-day dosing regimen for prednisone, and was also treated with a cycle of oral prednisone. In December 1993, substantial gingival hyperplasia was noted. The patient's gums also bled when she brushed her teeth. Her medications included cyclosporine, prednisone, azathioprine, potassium phosphate, conjugated estrogens, medroxyprogesterone, nifedipine, misoprostol, furosemide, lovastatin, and metoprolol. The patient was treated with a five-day course of azithromycin. The lovastatin was replaced with simvastatin. During a return visit on April 21, 1994, the patient stated that the gingival hyperplasia had improved and the bleeding had resolved. On examination, less gingival erythema and retraction of the gums were noted.
In both patients gingival hyperplasia improved after treatment with azithromycin. We are now beginning a controlled study to assess the effects of azithromycin on gingival hyperplasia associated with cyclosporine.
Erik Wahlstrom, M.D.
Jose U. Zamora, M.D.
Siegmund Teichman, M.D.
Loma Linda University Medical Center, Loma Linda, CA 92354- Citing Articles (19)
Citing Articles
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R. Hirsch, H. Deng, M. N. Laohachai. (2011) Azithromycin in periodontal treatment: more than an antibiotic. Journal of Periodontal Researchno-no
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R Hirsch. (2010) Periodontal healing and bone regeneration in response to azithromycin. Australian Dental Journal 55:2, 193-199
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Christine Macartney, Marshall Freilich, Isaac Odame, Karen Charpentier, Yigal Dror. (2009) Complete response to tacrolimus in a child with severe aplastic anemia resistant to cyclosporin A. Pediatric Blood & Cancer 52:4, 525-527
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Costas Fourtounas, Jannis G. Vlachojannis. (2009) Gingival Hyperplasia and Calcium Channel Blockers. The Journal of Clinical Hypertension 11:2, 111-111
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Vera L.C. Ramalho, Horácio J. Ramalho, José P. Cipullo, Reinaldo Azoubel, Emmanuel A. Burdmann. (2007) Comparison of Azithromycin and Oral Hygiene Program in the Treatment of Cyclosporine-Induced Gingival Hyperplasia*. Renal Failure 29:3, 265-270
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Jeong-Won Paik, Chang-Sung Kim, Kyoo-Sung Cho, Jung-Kiu Chai, Chong-Kwan Kim, Seong-Ho Choi. (2004) Inhibition of Cyclosporin A-Induced Gingival Overgrowth by Azithromycin Through Phagocytosis: An In Vivo and In Vitro Study. Journal of Periodontology 75:3, 380-387
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Deepa H. Chand, Joseph Quattrocchi, Stacy A. Poe, Geza T. Terezhalmy, C. Frederic Strife, Robert J. Cunningham. (2004) Trial of metronidazole vs. azithromycin for treatment of cyclosporine-induced gingival overgrowth. Pediatric Transplantation 8:1, 60-64
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K. E. Harman, E. M. Higgins. (2003) Case 4. Clinical and Experimental Dermatology 28:3, 341-342
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Robert Lee Page, J. Mark Ruscin, Doug Fish, Marc LaPointe. (2001) Possible Interaction Between Intravenous Azithromycin and Oral Cyclosporine. Pharmacotherapy 21:11, 1436-1443
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Paulo M. Camargo, Philip R. Melnick, Flavia Q. M. Pirih, Rodrigo Lagos, Henry H. Takei. (2001) Treatment of drug-induced gingival enlargement: aesthetic and functional considerations. Periodontology 2000 27:1, 131-138
CrossRef12
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CrossRef13
Orit Oettinger-Barak, Eli E. Machtei, Micha Peled, Shlomi Barak, Imad Abu L-Naaj, Dov Laufer. (2000) Cyclosporine A-Induced Gingival Hyperplasia Pemphigus Vulgaris: Literature Review and Report of a Case. Journal of Periodontology 71:4, 650-656
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Phillip J. Sheridan, Stephen J. Meraw. (1999) Medically Induced Gingival Hyperplasia. Mayo Clinic Proceedings 74:7, 743
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