Oral Sarcoidosis: Report of a Case and Review of Literature

Images of the month: Demonstrative oral mucosal sarcoidosis in a patient with pulmonary disease

Sarcoidosis is a multisystem granulomatous disease that preferentially affects the lungs and intrathoracic lymph nodes. Oral involvement is quite rare and usually appears in patients with known systemic sarcoidosis but it may also be the initial finding of a systemic disease. Herein, we report a case of asyptomatic pulmonary sarcoidosis with cutaneous and oral involvement. Recognising oral sarcoidosis may be difficult but it is important not to miss an asymptomatic pulmonary sarcoidosis. Patients with oral lesions of sarcoidosis should be screened for systemic disease.

Oral sarcoidosis aiding in diagnosis of underlying systemic disease

Sarcoidosis is a chronic, multisystemic, granulomatous disease of unknown aetiology characterised by the formation of non-caseating granuloma. It shows slight female predominance and has a bimodal age distribution. Lungs, skin, eye and liver are commonly affected. The oral lesion, though uncommon, may present as submucosal nodule, papule or superficial ulceration. Occasionally, oral lesion may be the first manifestation of underlying systemic disease. This case is interesting because it emphasises that dental practitioners may play a key role in early recognition of the clinical presentation of this multifaceted disease, and thereby aid in the diagnosis of the systemic condition. The present report deals with a case of sarcoidosis affecting the buccal mucosa in a 48-year-old woman. The patient was treated with oral prednisolone and within 4 months of corticosteroid therapy, the oral lesion regressed with no recurrence or new lesion noted over a period of 1 year.

Oral manifestation of sarcoidosis: A case report and review of the literature

Sarcoidosis is a common multisystemic granulomatous disease characterized by the formation of nonnecrotizing epithelioid granulomas in various body organs. The most commonly affected organs in the head-and-neck region include salivary glands and cervical lymph nodes. Involvement of the oral mucosa is very rare. The purpose of this report is to present an atypical oral manifestation of sarcoidosis with ulcerations of the buccal mucosa in a 59-year-old female.

Spontaneous Oral Mucosal Bleeding Unmasking Undiagnosed Sarcoidosis: A Case Report

Sarcoidosis is a multisystem, non-caseating, chronic, granulomatous disease affecting any organ. In the head and neck region, salivary glands and lymph nodes are most commonly involved. Oral manifestations are rare but these lesions, occasionally haemorrhagic, may be the first sign of systemic disease. It is important to recognize the oral manifestations of sarcoidosis and to be aware of potential secondary disease-driven processes, such as thrombocytopenia. The purpose of this paper is to present a previously undiagnosed case of sarcoidosis, initially presenting with oral manifestations, including mucosal bleeding, and to review the current literature on oral sarcoidosis. Clinical relevance: Oral lesions can be the first sign of undiagnosed systemic sarcoidosis.

[Cutaneous manifestations of sarcoidosis]

Sarcoidosis is a systemic granulomatous disorder of unknown aetiology. Its dermatological manifestations are extremely polymorphous. They are normally classed as either specific lesions, comprising granulomas, which are generally chronic, or non-specific lesions, principally acute erythema nodosum. These signs are seen in around 25% of sarcoidosis patients. The disease may be heralded by a skin disorder. Diagnosis of cutaneous sarcoidosis provides the clinician with three problems: screening for a visceral site of the disease, determination of the prognosis, and long-term management with regular monitoring coupled with suitable therapy in the event of cosmetic or functional impairment.

Sarcoidosis: Oral and extra-oral manifestation

Sarcoidosis is a multisystem granulomatous disease, which is usually associated with the formation of noncaseating granulomas in affected tissues and organs. It is mostly present with bilateral hilar lymphadenopathy, pulmonary infiltration, ocular, and cutaneous lesions. Oral manifestations of this disease are relatively rare. The present case report shows a 40-year-old male with lesions in the soft tissue of oral cavity (buccal mucosa, gingiva, and palate) and a diagnosis of sarcoidosis was established following hematological, biochemical and pulmonary function tests, chest radiograph, and histopathological investigation.

Orofacial granulomatosis: clinical signs of different pathologies

Orofacial granulomatosis (OFG) is an uncommon disease characterized by persistent or recurrent soft tissue enlargement, oral ulceration and a variety of other orofacial features. It could be an oral manifestation of a systemic disease. For a correct differential diagnosis, local and systemic conditions characterized by granulomatous inflammation should be excluded using appropriate clinical and laboratory investigations. In fact, the diagnosis of OFG may be confirmed only by histopathological identification of noncaseating granulomas. The literature from 1943 to 2014 was reviewed with emphasis on the etiology of OFG and on clinical manifestations of systemic pathologies associated with OFG. The precise cause of OFG is still unknown, although several theories have been suggested, such as infection, hereditary factors and allergy. OFG is a disease that has a wide spectrum of presentation, which may include the oral manifestation of a systemic condition such as Crohn's disease, sarcoidosis, granulomatosis with polyangiitis and Melkersson-Rosenthal syndrome.

Sarcoidosis presenting as isolated gingival enlargement: a rare case entity

Sarcoidosis is a non-caseating granulomatous disease . It is a multiorgan inflammatory disorder of unknown etiology. Conditions affecting skin or other organs frequently involve oral cavity and rarely manifest as gingival disease. Here we are reporting a rare case in which gingival hyperplasia was the initial symptom which finally led to the diagnosis of sarcoidosis. Oral mucous membrane needs to be examined carefully as it may constitute in presenting first sign of systemic sarcoidosis.

Oral Lesion as the first Clinical Presentation in Sarcoidosis: A Case Report

Sarcoidosis is a common multi-system disease characterized histolopathologically by the formation of non-caseating granulomas in the affected tissues. The oral involvement of sarcoidosis is relatively rare with less than 70 reported cases in literature while an oral lesion as the initial presenting sign is even less common. Oral lesions of sarcoidosis may mimic the lesions of other serious systemic diseases including Crohn's disease and tuberculosis as well as lesions localized to the orofacial region such as orofacial granulomatosis. This report presents a case of non-progressive sarcoidosis where the initial presenting symptom was a lesion in the buccal vestibule attached to the gingivae. A brief review of the pathology and clinical features is also presented.

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.