vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v24i1.2860vsp-3685Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL OBSERVATIONSРазвитие гиперплазии десен на фоне лечения циклоспорином и амлодипином ребенка с нефротическим синдромом и регресс после коррекции терапии: клинический случайGingival Hyperplasia Associated with Cyclosporine and Amlodipine Administration in a Child with Nephrotic Syndrome and Regression after Therapy Correction: Clinical Casehttps://orcid.org/0000-0001-5769-0450СтрокА. Б.StrokAlina B.

Строк Алина Борисовна, кандидат медицинских наук, доцент кафедры общей и клинической фармакологии; врач клинический фармаколог 

117198, Москва, ул. Миклухо-Маклая, д. 6, 

тел.: +7 (495) 936-90-28

Moscow

alina_strok@mail.ruhttps://orcid.org/0000-0002-7656-1539КостылеваМ. Н.KostylevaMaria N.

Москва

Moscow

https://orcid.org/0009-0004-6889-9697КостинаА. В.KostinaAnna V.

Москва

Moscow

РДКБ РНИМУ им. Н.И. Пирогова (Пироговский Университет); РУДН им. Патриса ЛумумбыРоссияRussian Children’s Clinical Hospital of Pirogov Russian National Research Medical University; Peoples’ Friendship University of RussiaRussian FederationРДКБ РНИМУ им. Н.И. Пирогова (Пироговский Университет); РНИМУ им. Н.И. Пирогова (Пироговский Университет)РоссияRussian Children’s Clinical Hospital of Pirogov Russian National Research Medical University; Pirogov Russian National Research Medical UniversityRussian FederationРДКБ РНИМУ им. Н.И. Пирогова (Пироговский Университет)РоссияRussian Children’s Clinical Hospital of Pirogov Russian National Research Medical UniversityRussian Federation2025250220252414553Copyright © Строк А.Б., Костылева М.Н., Костина А.В., 20252025Строк А.Б., Костылева М.Н., Костина А.В.Strok A.B., Kostyleva M.N., Kostina A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/3685Обоснование

Обоснование. Гиперплазия десен — патологическое диффузное или локальное разрастание фиброзной ткани в области десен и пародонта. Чрезмерный рост ткани десен может быть причиной воспаления пародонта и, как следствие, потери зубов, нарушения речи, жевания, эстетических изменений. Описанные случаи гиперплазии десен у детей на фоне терапии циклоспорином ограничены небольшой длительностью наблюдения (до 2 мес), не содержат информации о концентрации циклоспорина в крови и скорости регресса гиперплазии после отмены препарата.

Описание клинического случая. Ребенок, возраст 8 лет 10 мес, мужского пола, находился на стационарном лечении по поводу нефротического синдрома. В связи с появлением гиперплазии десен неоднократно обращался за по мощью к стоматологу — местная терапия без эффекта. В стационаре была пересмотрена терапия нефротического синдрома. Выявлены два препарата, которые могли спровоцировать развитие гиперплазии: циклоспорин (период применения — 5 лет 10 мес) и амлодипин (период применения — 1 год 6 мес). Назначен мониторинг концентрации циклоспорина в крови. Зафиксированы эпизоды повышения концентрации циклоспорина в крови выше рекомендованных значений. Препарат определен как наиболее вероятная причина лекарственной гиперплазии десен. Амлодипин рассматривали как аддитивный фактор, усугубляющий побочный эффект. Оба препарата отменены. Спустя 9 мес при повторном поступлении в стационар отмечен регресс гиперплазии десен.

Заключение

Заключение. Применение препаратов, ассоциированных с высоким риском развития гиперплазии десен, требует динамического наблюдения для своевременной коррекции терапии и предупреждения серьезных последствий такого лечения. Однако мониторинг концентрации циклоспорина не гарантирует предупреждения развития побочных эффектов.

Background

Background. Gingival hyperplasia is a pathological diffuse or local outgrowth of fibrous tissue in the gums and paradontium. Excessive growth of gum tissue can cause periodontal inflammation and results in tooth loss, speech and chewing issues, aesthetic changes. The described cases of gingival hyperplasia in children on cyclosporine therapy are limited by the short follow-up (up to 2 months) and do not contain data on cyclosporine levels in the blood and hyperplasia regression after treatment cessation.

Clinical case description. The child, 8 years 10 months old, male, was hospitalized for nephrotic syndrome management. He was consulted by the dentist several times due to gingival hyperplasia; topical therapy had no effect. Therapy of nephrotic syndrome was revised during hospital stay. Two drugs were identified that could provoke the hyperplasia development: cyclosporine (on-treatment period — 5 years 10 months) and amlodipine (on-treatment period — 1 year 6 months). Monitoring of ciclosporin levels in blood was prescribed. Episodes of increased cyclosporine levels (above the recommended values) were recorded. The drug was considered as the most likely cause of drug-induced gingival hyperplasia. Amlodipine was considered as additive factor exacerbating the side effect. Both drugs were discontinued. Gingival hyperplasia regression was noted 9 months later at return to the clinic.

Conclusion

Conclusion. Administration of drugs associated with high risk of gingival hyperplasia development requires dynamic follow-up for timely therapy correction and severe complications prevention.

However, monitoring of ciclosporin levels does not guarantee the prevention of side effects.

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The authors declare that there are no conflicts of interest present.