Primary mucocutaneous tuberculosis of the lower lip, without pulmonary or systemic involvement, is an uncommon presentation of cutaneous tuberculosis. The rare combination of lower lip swelling, vermilion border beading, gingival hyperplasia and nasal crusting, as seen in our adolescent patient further adds to the atypical nature of the disease while also highlighting diagnostic complexity. We therefore urge dermatologists to keep a high index of clinical suspicion and undertake relevant investigations to actively rule out tuberculosis especially in endemic areas in cases of chronic non-healing lip lesions.

TAFRO syndrome is an infrequent and severe systemic inflammatory condition marked by thrombocytopenia, anasarca, fever, reticulin fibrosis/renal dysfunction, and organomegaly. Although tocilizumab has shown clinical efficacy in inducing initial disease control, evidence on sustained long-term remission beyond three years following anti-interleukin-6 therapy remains limited. We present a 46-year-old female who was admitted with worsening edema, gingival bleeding, and severe thrombocytopenia, initially misdiagnosed as idiopathic thrombocytopenic purpura with no clinical response. A comprehensive diagnostic workup demonstrated multisite serosal effusions (pleural fluid accumulation, pericardial fluid accumulation, and abdominal free fluid), enlarged cervical lymph nodes, grade 1-2 reticulin myelofibrosis with megakaryocytic hyperplasia, Castleman disease-like features on nodal histopathological examination, and increased serum interleukin-6 levels (19.2 pg/mL). The patient fulfilled all major and multiple minor diagnostic criteria for TAFRO syndrome. Treatment consisted of combination therapy with cyclophosphamide, corticosteroids, plasmapheresis, and tocilizumab administered biweekly for a total of eight doses. Complete resolution of thrombocytopenia, anemia, and inflammatory markers was observed after five cycles of tocilizumab. Comprehensive clinical, laboratory, and radiological surveillance showed sustained complete remission for more than three years, without evidence of disease relapse. This report highlights the potential role of tocilizumab-based therapy in achieving prolonged clinical remission in selected patients with TAFRO syndrome, particularly when interpreted within the overall clinical and laboratory context.

Arteriovenous malformations (AVMs) are high-flow congenital vascular anomalies characterized by abnormal direct communication between arteries and veins, bypassing the capillary bed. Gingival enlargement or gingival overgrowth is a common gingival disease characterized by an increase in the size of the gingival tissues. The main factors of gingival enlargement are inflammation, drugs, systemic conditions or diseases, neoplastic or false enlargements, and local factors, such as plaque, calculus, and/or overhanging restorations. The purpose of this article is to present an interesting case of the management of a patient with mandibular gingival enlargement occurring in association with an underlying AVM.  A 24-year-old non-smoker female patient presented to the periodontal clinic for the evaluation of a gingival overgrowth on the right side of the mandible that had developed over a four-week period, following a referral from her vascular specialist. Patient was previously diagnosed with an intraosseous AVMs in jaws (j-AVMs). Her medical history consisted of undergone embolization therapy for the j-AVM one year before. Clinical evaluation revealed an asymptomatic, soft-consistency, red/purple tumor-like mass with a broad base, measuring 0.5 x 0.5 cm. The surrounding gingival tissues in the right mandibular region appeared hyperplastic and edematous. A diagnosis of generalized gingivitis was established. The region of AVM was topographically associated with the vascular lesion of the mandibular gingiva. The gingival hyperplasia was distinguished from the underlying AVM, clarifying that the two represented coexisting independent lesions. The coexistence of gingival overgrowth with an underlying intraosseous AVM is exceptionally uncommon and presents notable challenges in clinical management and treatment. This case highlights the importance of adopting a conservative and multidisciplinary management approach, particularly in patients with high-flow vascular anomalies, where invasive procedures may pose substantial risks. Effective management relies on close collaboration among dental clinicians, radiologists, and vascular specialists.

Drug-induced gingival overgrowth (DIGO) is a multifactorial adverse effect associated with calcium channel blockers and antiepileptic drugs, yet genetic susceptibility-particularly in Asian populations-remains poorly defined. We performed whole-genome sequencing in 74 Thai individuals, including 36 DIGO cases and 38 drug-exposed nonresponder controls. A genome-wide association study was conducted with adjustment for amlodipine exposure, which showed a significant association with DIGO. Complementary analyses included gene-based testing using Multi-marker Analysis of GenoMic Annotation, fine-mapping with Sum of Single Effects, haplotype analysis, and receiver operating characteristic-based risk modeling. Although no single nucleotide polymorphisms (SNPs) reached genome-wide significance, we identified 350 lead SNPs across 34 genes showing strong associations with DIGO (p < 0.001). After multiple-testing correction, six genes/SNPs remained statistically significant (p < 0.05), representing the most robust findings. Haplotype analysis implicated TTC7B, RWDD1, TOM1L1, C1QL2, and BBS1 as DIGO risk genes. These genes, not previously linked to DIGO, are involved in cellular trafficking, phosphoinositide signaling, ciliary function, and protein regulation. Our findings indicate that DIGO susceptibility is driven by genetically determined cellular response pathways in the presence of amlodipine rather than by pharmacokinetic mechanisms. The absence of associations with CYP2C9 and HLA variants previously reported in other populations highlights the importance of ethnically diverse pharmacogenomic studies.

Leukemia cutis is an uncommon extramedullary manifestation of acute myeloid leukemia (AML) caused by infiltration of the skin by leukemic blasts. Its clinical morphology is highly variable and may mimic infectious, inflammatory, or other neoplastic dermatoses, making tissue diagnosis essential. We report a 49-year-old man who presented with fever, epistaxis, and multifocal nodular and ulcerated skin lesions involving the right wrist, chest, and scalp, as well as gingival hyperplasia. Skin biopsy was reported to confirm cutaneous myeloid sarcoma, consistent with leukemia cutis in the setting of AML. Histopathology demonstrated dense dermal infiltration by atypical myeloid cells with relative epidermal sparing. The patient was diagnosed with AML with cutaneous involvement and was started on systemic chemotherapy. This case emphasizes the importance of early biopsy of suspicious skin lesions in patients with known or suspected hematologic malignancy and highlights the adverse prognostic implications of leukemia cutis.

Vitamin C, also known as ascorbic acid, plays a pivotal role in forming blood vessels, cartilage, muscles, and collagen in bones. We report a 6-year-old non-verbal female with global developmental delay who presented with complaints of lower limb pain and inability to bear weight. Symptoms started five weeks prior to presentation and had progressed from decreased activity to complete loss of weight-bearing. Physical examination showed gingival hyperplasia, perifollicular petechiae, lower limb edema, and corkscrew hair. Initial radiologic findings raised concerns of osteomyelitis, showing bone marrow edema, periosteal reaction, and cortical irregularity. However, correlation with dietary history limited to flavored milk and yogurt and lacking fruits and vegetables, in conjunction with clinical presentation, suggested vitamin C deficiency, and she was started on ascorbic acid. Vitamin C deficiency was later confirmed on day 7 by a low C deficiency level (<0.1 mg/dL). Treatment with ascorbic acid, multivitamins, and supportive therapy led to gradual recovery, and gastrostomy tube placement facilitated supplementation. This case highlights the importance of detailed dietary history and recognition of clinical signs of vitamin C deficiency. Early dietary assessment and clinical correlation can prevent unnecessary invasive procedures and prolonged antibiotic therapy. Early identification enables timely intervention, reducing morbidity and improving quality of life.

OBJECTIVE: This study aimed to assess the prevalence of calcium channel blocker (CCB)–induced gingival hyperplasia (GH) and to identify associated risk factors among patients undergoing peritoneal dialysis (PD). METHODS: A retrospective analysis was performed on 303 patients receiving CCB therapy while undergoing PD at the General Hospital of Ningxia Medical University. Based on clinical assessment, patients were categorized into a GH group (n = 48) and a non-GH group (n = 255). Demographic characteristics and inflammatory biomarkers were compared between groups. Independent factors associated with GH were evaluated using logistic regression analysis. RESULTS: Patients with GH were younger and had longer durations of PD and shorter CCB exposure compared to those without GH (all p < 0.05). No significant differences were observed between groups with respect to CCB class or dosage, dialysis dose, volume load, ultrafiltration volume, or residual urine volume (p > 0.05). Compared with the non-GH group, patients with GH showed lower reticulocyte counts and higher levels of alkaline phosphatase, uric acid, and prealbumin (all p < 0.05). Serum calcium, phosphorus, parathyroid hormone, urea, creatinine, C-reactive protein, β2-microglobulin, albumin, and potassium levels did not differ significantly between groups (p > 0.05). Circulating concentrations of interleukin-6 and transforming growth factor–β1 were also comparable (p > 0.05). Multivariable logistic regression identified shorter duration of PD [odds ratio (OR) = 0.703, 95% confidence interval (CI): 0.581–0.851, p < 0.001] and shorter duration of CCB exposure [OR = 0.959, 95% CI: 0.931–0.988, p = 0.006] as protective factors against the development of CCB-induced GH. CONCLUSION: Shorter duration of both PD and CCB exposure were associated with lower odds of gingival hyperplasia. These findings underscore the need for careful clinical surveillance in patients receiving long-term CCB therapy during PD.

This narrative review describes the scientific evidence on drug-induced gingival overgrowth (DIGO) in kidney transplant patients treated with immunosuppressive agents, particularly Cyclosporine A, focusing on its prevalence, pathogenetic mechanisms, and clinical management strategies.

The aim of this study was to describe the clinical microscopic features of localized juvenile spongiotic gingival hyperplasia (LJSGH) using an operating microscope (OM), a non-invasive technique rarely applied to oral mucosal lesions. An 18-year-old female presented with asymptomatic gingival redness and bleeding affecting the buccal gingiva of previously orthodontically treated maxillary canines. Conventional clinical examination revealed gingival recession, erythema, and edema. OM evaluation enabled detailed visualization of gingival surface irregularities, superficial vascular spots, exudation, and friable tissue that bled upon touch and probing. An incisional biopsy was performed. Histopathological analysis showed acanthosis, spongiosis, exocytosis, congested capillaries at the epithelium-connective tissue interface, and a dense inflammatory infiltrate in the lamina propria, confirming the diagnosis of LJSGH. In conclusion, OM allowed the identification of vascularity, exudation, surface irregularity, and tissue friability, features not apparent in conventional clinical examination. These findings suggest that OM is a valuable adjunct for evaluating and documenting gingival lesions.