Our patient was a 33-year-old woman who had received allogenic stem cell transplant for hepatosplenic T-cell lymphoma. She was administered ciclosporin, 150mg/d, as prophylaxis for graft-versus-host disease and developed progressive gingival hyperplasia, most evident 2 months after starting treatment (Fig. 1A). She was then administered azithromycin, 500mg daily for 3 days, which produced a considerable improvement at 3 weeks (Fig. 1B).

Figure 1

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Gingival hyperplasia is a known complication of treatment with ciclosporin. It occurs in approximately 30% of cases, but its pathogenesis remains unknown. The mechanism of action of azithromycin is not fully understood, but it has been suggested that the drug may have a triple action in the resolution of certain periodontal diseases, due to its antimicrobial and anti-inflammatory activity and its capacity to persist at low concentrations in the macrophages and fibroblasts of the periodontal tissues, even when administered in short-term regimens of 3 to 5 days.

In more prolonged treatments, the interaction that occurs between the 2 drugs would require ciclosporin levels to be monitored and great care to be taken in patients with alterations of cardiac repolarization.