Multisystem sarcoid presenting with gingival hyperplasia

Gingival enlargement unveiling sarcoidosis: Report of a rare case

Sarcoidosis is classified as an acquired systemic granulomatous disease. Because of the fact that sarcoidosis affects multiple tissues and organs, it is characterized by many potential signs and symptoms, as well as by the presence of non-caseating granulomas in the organs involved. Although oral sarcoidosis is relatively rare, it may however, present in the oral cavity. This report presents a rare case of sarcoidosis with the initial presenting symptom as severe generalized gingival enlargement. The gingival enlargement was treated by gingivectomy. After histopathological examination of gingival biopsy and certain special investigations, a diagnosis of sarcoidosis was made.

Oral involvement in sarcoidosis: report of 12 cases

AIM

To assess the clinical features, treatment and outcome of oral sarcoidosis and to determine whether oral involvement is associated with a particular clinical phenotype of sarcoidosis.

DESIGN

Multicentric retrospective study.

METHODS

Retrospective chart review. Each patient was matched with four controls.

RESULTS

Twelve patients (9 women, 3 men) were identified. Their median age at sarcoidosis diagnosis was 38 years. Oral involvement was the first clinical evidence of sarcoidosis in seven cases and was a relapse symptom in five cases. Clinical presentations were nodules (n = 7) or ulcers (n = 5) and were mostly solitary. The tongue was the commonest site affected (n = 4), followed by lips (n = 3), oral mucosa (n = 2), palate (n = 2) and gingiva (n = 1). Patients with oral sarcoidosis were significantly younger and had more frequent lacrimal or salivary glands and upper airway tract clinical involvement than the controls; increased angiotensin-converting enzyme was less frequent in oral sarcoidosis. Multiple treatments of oral sarcoidosis were used: no treatment (n = 3), surgery (n = 2), corticosteroids (n = 7), hydroxychloroquine (n = 3), methotrexate (n = 2), doxycycline (n = 1). Methotrexate was efficient in one patient, hydroxychloroquine showed benefit in only 1 out of 3 patients. Three patients presented oral relapses. After a mean follow-up of 6 years, 10 patients experienced a complete (n = 7) or partial (n = 3) remission of oral sarcoidosis; stability was observed in the remaining two cases.

CONCLUSION

Although oral manifestations of sarcoidosis are unusual, physicians should be aware that this specific localization is frequently the first manifestation of the disease. Treatment modalities range from observation in asymptomatic patients to immunosuppressants for severe involvement.

Oral sarcoidosis: a review of literature

Sarcoidosis is a common systemic granulomatous disease affecting multiple organs. Oral involvement is relatively rare and, to our knowledge, there have been only 64 cases reported in the English literature. Most cases of oral sarcoidosis present with mobility of the teeth due to rapid alveolar bone loss. Other oral manifestations include asymptomatic swelling of the involved mucosa, gingivitis and ulcers. Diagnosis of sarcoidosis is by exclusion as no specific test is available. Radiographic, biochemical and histological findings are non-specific, but helpful. All cases of sarcoidosis do not require treatment. Corticosteroids are the treatment of choice in patients requiring treatment. Other drugs such as chloroquine, methotrexate, infliximab and thalidomide are also used in the treatment of sarcoidosis. In most of the oral cases reported, systemic steroids and surgery were the preferred treatment.

Diffuse gingival enlargement

Diffuse gingival enlargement is defined as an excessive growth of periodontal tissue. It can be considered a relatively common finding, as thousands of patients have been described in the literature. Patients may seek medical attention because of pain, tenderness, interference with speech and/or mastication, halitosis, or unsightly appearance, or gingival enlargement may be an unexpected finding on routine physical examination. Diffuse gingival enlargement has numerous causes, including poor dental hygiene, medications, serious systemic illnesses, genetic conditions, other specific physiologic states, or it may be idiopathic. Given the large number of possible underlying conditions, the work-up of a patient presenting with diffuse gingival enlargement may seem daunting. We present a systemic review of diffuse gingival enlargement, including an algorithm that can be used to direct the work-up of patients presenting with this condition.

Sarcoidosis With Gingival Involvement: A Case Report

BACKGROUND

The case outlined is a rare presentation of sarcoidosis intraorally associated with gingival ulceration.

METHODS

The diagnosis was made following a gingival biopsy.

RESULTS

The patient was subsequently referred to a physician for clinical management and the condition resolved without active treatment.

CONCLUSIONS

Sarcoidosis should be considered in the differential diagnosis of persistent swellings and ulceration of the oral mucosa. Intraoral sarcoid lesions are often the first indication of systemic involvement. It is important to make the diagnosis and monitor the condition as sarcoidosis is progressive if untreated in a small number of those affected.

Oral manifestations of sarcoidosis

OBJECTIVE

To report two new cases of sarcoidosis of the buccal mucosa and to analyze the literature on oral manifestations of sarcoidosis.

STUDY DESIGN

Oral lesions with histologic features of sarcoidosis were analyzed according to their location and appearance.

RESULTS

Analysis of 45 cases of oral sarcoidosis (43 from the literature and the 2 new presented cases) revealed 12 lesions in the jaws, 10 in the buccal mucosa, 6 in the gingiva, 5 in the lips, 5 in the floor of the mouth, 4 in the tongue, and 3 in the palate. Sarcoidosis in the jaw was located in the alveolar bone and presented as an ill-defined radiolucency. Submucosal nodules were observed in sarcoidosis affecting the buccal mucosa, palate, and lip. Swelling was the main manifestation in the gingiva. In the floor of the mouth, sarcoidosis presented as ranula and that of the tongue as induration. In most of the cases, the lesions in the buccal mucosa, gingiva, and tongue were the first clinical manifestation of the disease.

CONCLUSION

Oral sarcoidosis lesions should be considered in the differential diagnosis of oral soft tissue swellings and jaw lesions.

Granulomatous cheilitis in two children with sarcoidosis

Sarcoidosis is rare in children, who usually have only asymptomatic pulmonary involvement. We report granulomatous cheilitis in two children with sarcoidosis. Both children had systemic sarcoidosis with lymph node and pulmonary involvement.

Sarcoidosis with maxillary involvement

A case of sarcoidosis with maxillary involvement is presented. The patient complained of loose teeth in the upper anterior region, while radiographs revealed a poorly defined radiolucent area round the midline of the anterior maxilla. The diagnosis was verified by histopathologic examination.