An unusual case of multiple oral pyogenic granuloma, ¿associated with treatment with levothyroxin?

Abstract

El Granuloma piógeno (GP) es una lesión tumoral, no neoplásica, vascular, generalmente solitaria, que se presenta en la cavidad oral o piel, la etiología aún no está muy clara, se considera que es una lesión reactiva a varios estímulos de bajo grado, entre los cuales podemos contar traumas repetidos, agresiones, factores hormonales y ciertos fármacos. El GP múltiple, es un fenómeno raro, generalmente asociado al uso de drogas, como la carbamacepina, ciclosporina, retinoides, levotiroxina, etc. Se presenta el caso de una paciente de 50 años, referida por presentar aumento de volumen en reborde alveolar del primer, tercer y cuarto cuadrantes; con antecedentes de psoriasis eritrodermica e hipotiroidismo, en tratamiento con levotiroxina aproximadamente seis meses antes que se presenten las lesiones; se realiza exeresis quirúrgica y curetaje subperiostico, se enviaron las muestras a anatomía patológica, confirmándose el diagnóstico definitivo de GP; por los antecedentes, y la aparición casi simultánea de las lesiones en múltiples cuadrantes, se sospecha que estas, están asociadas al consumo terapéutico de levotiroxina para el hipotiroidismo.

Oral Pyogenic Granuloma: A Narrative Review

“…These factors are summarized in Figure 1. Pyogenic granuloma (PG) may manifest after a hypersensitivity reaction associated with the use of drugs such as calcineurin inhibitors (cyclosporine and tacrolimus), carbamazepine, phenytoin, nifedipine, levothyroxine and ramucirumab [20][21][22][23][24][25][26][27]. Additionally, PG is associated with retinoid, antineoplastic and antiretroviral agents [20].…”

“…Cheney et al described a case series in which they included five pediatric/adolescent patients who developed oral PG after HCT for acute lymphoblastic leukemia, Fanconi anemia, nodular sclerosis Hodgkin's lymphoma, or junctional epidermolysis bullosa [21]. It was suggested that calcineurin inhibitors, which are used for graft versus host disease, play a crucial role due to irritation and chronic inflammatory changes in the oral cavity, leading to tissue Pyogenic granuloma (PG) may manifest after a hypersensitivity reaction associated with the use of drugs such as calcineurin inhibitors (cyclosporine and tacrolimus), carbamazepine, phenytoin, nifedipine, levothyroxine and ramucirumab [20][21][22][23][24][25][26][27]. Additionally, PG is associated with retinoid, antineoplastic and antiretroviral agents [20].…”

“…Regarding carbamazepine, the release of angiogenic factors stimulated by the inflammatory process and the impairment of liver functions contribute to the development of PG [23]. Levothyroxine has been considered a possible etiological factor in PG through its pro-angiogenic and proliferative effects [24]. Piraccini et al reported that a side effect in psoriasis or acne patients treated with retinoids (systemic isotretinoin, systemic etretinate, systemic acitretin, topical retinoic acid, and topi-cal tazarotene) is the appearance of periungual PGs.…”

Oral Pyogenic Granuloma: A Literature Review

“…These factors are summarized in Figure 1. Pyogenic granuloma (PG) may manifest after a hypersensitivity reaction associated with the use of drugs such as calcineurin inhibitors (cyclosporine and tacrolimus), carbamazepine, phenytoin, nifedipine, levothyroxine and ramucirumab [21][22][23][24][25][26][27][28][29]. Additionally, PG is associated with retinoid, antineoplastic and antiretroviral agents [21].…”

“…Regarding carbamazepine, the release of angiogenic factors stimulated by the inflammatory process and the impairment of liver functions contribute to the development of PG [24]. Levothyroxine has been considered a possible etiological factor in PG through its pro-angiogenic and proliferative effects [25]. Piraccini et al (2010) reported that a side effect in psoriasis or acne patients treated with retinoids (systemic isotretinoin, systemic etretinate, systemic acitretin, topical retinoic acid, and topical tazarotene) is the appearance of periungual PGs.…”