Start practicing

Pathology · patient case question

All of the following belong in the differential diagnosis of gingival ENLARGEMENT of this type EXCEPT:

Patient case: Generalized gingival enlargement in a patient on multiple medications

Patient: Male, 45 years old

Chief Complaint: “My gums are growing over my teeth.”

Background: Epilepsy controlled on phenytoin for nine years. Hypertension on amlodipine. Renal transplant six years ago, on ciclosporin. Irregular brushing, no interdental cleaning.

Vital Signs: BP 136/86 mmHg · HR 76 bpm · T 98.2°F

Findings: Firm, pale, stippled gingival enlargement beginning at the interdental papillae and extending to cover up to a third of several clinical crowns, most marked anteriorly and on the labial surfaces. Heavy plaque and calculus. No ulceration, no fever, no lymphadenopathy.

  1. Primary herpetic gingivostomatitis
  2. Vitamin C deficiency
  3. Hereditary gingival fibromatosis
  4. Leukaemic gingival infiltration
Show answer and explanation

Correct answer: A. Primary herpetic gingivostomatitis

  • A. CORRECT as the exception. PRIMARY HERPETIC GINGIVOSTOMATITIS is an acute VESICULO-ULCERATIVE infection — a febrile child or young adult with painful vesicles that rupture into shallow ulcers, fiery erythematous gingiva, malaise and cervical lymphadenopathy. It causes acute inflammatory erythema and oedema, not the firm fibrous overgrowth described here, and it resolves within ten to fourteen days.
  • B. Scurvy produces swollen, spongy, haemorrhagic gingiva from defective collagen cross-linking. It is soft and bleeds readily rather than firm, but it belongs in the differential of an enlarged gingiva.
  • C. Hereditary gingival fibromatosis gives generalized, firm, pale, dense fibrous enlargement that may bury the crowns entirely. It appears around the time of eruption and is the non-drug mimic of this presentation.
  • D. Leukaemia, particularly acute myelomonocytic leukaemia, produces gingival enlargement by direct infiltration with leukaemic cells. It is boggy, bluish-red and bleeds easily, and it is the diagnosis you must not miss.

Note: Sort the differential by CONSISTENCY. FIRM and fibrous: drug-influenced enlargement, hereditary gingival fibromatosis. SOFT and haemorrhagic: scurvy, leukaemic infiltration, pregnancy-associated enlargement. ACUTE and ulcerated: herpetic gingivostomatitis, necrotizing gingivitis — these are not enlargements at all.

Practice Pathology questions Pathology study notes

More Pathology practice questions