By vgreene, 2 July, 2021

HTN

(BMJ)—A man in his 40s with hx of paroxysmal SVT treated with diltiazem for 6 months presented with a 3-month hx of swollen, painless, bleeding gums. Exam: overgrowth of interdental papilla, with attached and marginal gingiva covering nearly the whole crown of each tooth. What’s the likely cause?
Sarcoidosis
Hereditary gingival hyperplasia
Diltiazem
Plasma cell gingivitis
Infectious gingivitis
You are correct. Gingival hyperplasia is a side effect of diltiazem (in up to 3% of patients) that might occur weeks or months after initiation. The mechanism leading to hyperplasia remains unclear. Differential dx includes hereditary gingival hyperplasia, enlargement secondary to poor oral hygiene, and, rarely, plasma cell blood dyscrasias.

The patient was switched to an alternative tx and the hyperplasia regressed.

BMJ 2021;373:n1131