Drug-Induced Gingival Overgrowth Associated With Cyclosporine Therapy: A Case Report of a 23-Year Periodontal Follow-Up in a Heart Transplant Recipient

Drug-induced gingival overgrowth (DIGO) is a common adverse effect of cyclosporine therapy, which is widely used as an immunosuppressive agent in solid organ transplant recipients. This case report describes the 23-year follow-up of a male patient with a history of orthotopic heart transplantation, performed two years prior to his first dental visit in 2002, who developed DIGO under long-term cyclosporine therapy. At the initial periodontal evaluation, a diagnosis of localized Stage I, Grade A periodontitis associated with gingivitis was made, and nonsurgical mechanical debridement, scaling and root planing, and tailored oral hygiene instruction were provided, yielding favorable early outcomes and long-term periodontal stability. After many years of stability, the patient returned following a three-year lapse in maintenance, presenting with marked gingival enlargement, bleeding on probing, discoloration, and migration of the maxillary central incisors, consistent with progression to Stage II, Grade B periodontitis. Nonsurgical retreatment was performed, and DNA-based metagenomic analysis of subgingival plaque and tongue biofilm revealed a dysbiotic microbial profile, including the persistence of key periodontopathogenic taxa associated with tissue destruction and alveolar bone loss. This case underscores the importance of sustained periodontal maintenance in transplant recipients receiving cyclosporine therapy and illustrates that even after decades of apparent stability, DIGO and periodontal deterioration may reemerge if maintenance care is interrupted. The integration of DNA-based metagenomic analysis provided valuable diagnostic and motivational support, reinforcing a personalized, multidisciplinary approach to long-term periodontal management in immunosuppressed patients.