A Case Report of a Gingival Plasma Cell Granuloma in a Patient on Antihypertensive Therapy: Diagnostic Enigma

Abstract

The aim of the present report was to discuss a unique case of gingival plasma cell granuloma (PCG) in a hypertensive patient on Amlodipine therapy. Also, we attempt to emphasize the importance of considering primary and advance investigations before making a definite diagnosis. PCG is an extremely rare, reactive, non-neoplastic lesion characterized by the predominance of polyclonal plasma cells. Drug-induced gingival overgrowth is a known side effect of Amlodipine. A hypertensive 60-year-old female patient reported with a chief complaint of swollen gums and discomfort in the upper front teeth region. A provisional diagnosis of Amlodipine-induced gingival overgrowth, combined gingival overgrowth, and fibroma was suggested. Surprisingly, histopathology revealed it to be a plasma cell lesion which was confirmed by advanced investigations, thereby establishing a confirmatory diagnosis of PCG.

Necrotizing Ulcerative Gingivitis, a Rare Manifestation as a Sequel of Drug-Induced Gingival Overgrowth: A Case Report

“…The gingival biopsy revealed squamous epithelium hyperplasia with underlying chronic inflammation (Figures 12 and 13 ), consistent with a reactive process, and negative for hyperkeratosis and atypia. These reports are consistent with a secondary inflammatory reaction (NUG) as a manifestation of amlodipine-induced gingival overgrowth [ 21 ]. The current case is similar to a case report where DM type 2, hypercholesterolemia, and amlodipine for hypertension were of similar findings.…”

“…al found an unusual plasma cell granuloma formation secondary to GO. This case report states that biopsies for unusual lesions should be comprehensively examined regardless of clinical appearance or treatment success rate in order to rule out neoplasms and plan for treatment accordingly [ 21 ]. For this case, a biopsy was sent with a gross description of the tissue sample, it consisted of two pieces of gray white to brown tissue measuring 2.0 × 0.8 × 0.5 cm and 1.5 × 1.4 × 0.8 cm.…”

Calcium Channel Blockers Induced Gingival Overgrowth

“…No recurrence was reported 5 months after treatment. In a similar case, Gulati et al [ 44 ] reported a 60-year-old hypertensive female who was on 20 mg of amlodipine daily. She presented with GO as nodular, polypoid masses with a smooth surface.…”

Gingival plasma cell granuloma: The importance of histological analysis

“…A polyclonal population of plasma cells, with a kappa to lambda light chain ratio of 2:1, is suggestive of a reactive aetiology 8 . Possible causes include reaction to allergens, chronic periodontitis and periradicular inflammation 9 . Other reported PCGs, out with the oral cavity, have been reported in response to a foreign antigen such as Epstein–Barr virus and Human Herpes virus‐8 10 .…”

“…7 A polyclonal population of plasma cells, with a kappa to lambda light chain ratio of 2:1, is suggestive of a reactive aetiology. 8 Possible causes include 9 Other reported PCGs, out with the oral cavity, have been reported in response to a foreign antigen such as Epstein-Barr virus and Human Herpes virus-8. 10 Amlodipine and cyclosporin are also known to induce PCGs of the gingivae.…”