Drug-induced pemphigus-like lesion accompanied by severe gingival enlargement

Abstract

Pemphigus-like gingival lesions are common in elderly individuals who are on long-term systemic medications. We report the case of a patient with drug-induced pemphigus-like lesion with severe gingival enlargement who was examined using histological and immunohistochemical methods. A 67-year-old woman with a history of breast cancer and on antihypertensive therapy complained of tumorous gingival enlargement in the left premolar and molar regions of both arches. The involved teeth showed extensive bony destruction, and a malignant tumor was suspected. Cytological examination revealed several round-to-polygonal acantholytic keratinocytes with normal nuclei. Severe gingival inflammation accompanied by extensive acantholysis of the surface epithelium caused multiple erosions and ulcerations in the absence of tumor growth. β-catenin was weakly expressed in the erosive epithelium, whereas LC3 and GADD45 were found to be strongly positive. These findings suggested that the erosive epithelium had slowly degenerated via autophagy and cellular growth arrest. Thus, the erosive epithelium was suspected to be chronically damaged by certain drugs rather than by acute cytotoxic changes. Following drug cessation, the gingival hyperplasia rapidly regressed with simple oral hygiene care and partial gingivectomy. Drug-induced pemphigus-like lesions can be diagnosed using detailed medical history and pathological examinations and should be followed by a conservative treatment.