{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:12:32Z","timestamp":1790241152753,"version":"4.1.0"},"reference-count":9,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Gingival enlargement is an adverse effect of certain medications, most notably calcium channel blockers, immunosuppressants, and anticonvulsants. We report the case of a 15\u2010year\u2010old male with end\u2010stage renal disease who developed severe drug\u2010induced gingival enlargement (DIGE) following a deceased donor renal transplant. His immunosuppressive regimen included tacrolimus, prednisone, mycophenolate mofetil, and thymoglobulin, later supplemented with nifedipine for hypertension. Three years after transplant, he developed progressively severe gingival enlargement, leading to impaired mastication, weight loss, and symptoms of sleep\u2010disordered breathing. Examination revealed marked maxillary and mandibular hyperplasia with pedunculated lesions and enlarged tonsils. Imaging confirmed vascular gingival lesions without bony involvement. The patient underwent operative debulking of the gingival tissue using a Gigli saw and scissors, with adjunctive hemostatic measures, as well as tonsillectomy. Histopathology confirmed fibromatosis with chronic inflammation consistent with DIGE. Postoperatively, the patient demonstrated significant clinical improvement, with weight gain, restoration of oral intake, and satisfactory gingival healing at 3\u2009weeks. This case highlights the complex interplay between immunosuppressants, calcium channel blockers, and oral health in pediatric transplant recipients. Although minor DIGE may regress with medication adjustment and improved oral hygiene, severe cases often necessitate surgical management. Early recognition, interdisciplinary collaboration, and timely surgical intervention are essential to restore function and quality of life in affected patients, particularly those who are immunosuppressed.<\/jats:p>","DOI":"10.1002\/ccr3.71128","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T06:07:10Z","timestamp":1760594830000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Surgical Management of Severe Drug\u2010Induced Gingival Hypertrophy: A Case Report"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3601-3800","authenticated-orcid":false,"given":"John J.","family":"Alfarone","sequence":"first","affiliation":[{"name":"Norton College of Medicine SUNY Upstate Medical University  Syracuse New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Hatala","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Communication SUNY Upstate Medical University  Syracuse New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhruv","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Communication SUNY Upstate Medical University  Syracuse New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherard","family":"Tatum","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Communication SUNY Upstate Medical University  Syracuse New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/dj12120403"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.25009"},{"key":"e_1_2_14_4_1","volume-title":"UpToDate","author":"Keels M.","year":"2025"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.4103\/jomfp.JOMFP_50_20"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600\u2010051x.2001.028009848.x"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u2010051X.2006.00940.x"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972\u2010124X.134567"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1999.70.1.63"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1997.68.7.676"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71128","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.71128","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71128","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T08:53:42Z","timestamp":1790240022000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.71128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":9,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1002\/ccr3.71128"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.71128","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2025-07-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71128"}}