A 62-year-old man presented to an oral medicine specialist with gingival inflammation of at least 1 year's duration. He reported mild discomfort when consuming spicy foods and denied associated extraoral lesions. His medical history revealed hypertension, hypothyroidism, and psoriasis. Medications included lisinopril 10 mg and levothyroxine 100 µg daily. No known drug allergies were reported. His family and social history were noncontributory, and a detailed review of systems was unremarkable.

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... xtraoral examination revealed no lymphadenopathy, salivary gland enlargement, or thyromegaly. Intraoral examination revealed diffuse enlargement of the maxillary and mandibular gingiva accompanied by severe erythema and bleeding on provocation. A 3-mm punch biopsy of the gingiva was performed for routine analysis and direct immunofluorescence. WHAT'S YOUR DIAGNOSIS? a. extramedullary plasmacytoma b. mucous membrane pemphigoid c. oral lichen planus d. pemphigus vulgaris e. plasma cell gingivitis