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Majid I, Martel JB, Martel B, Martel M. Presentation and Management of Life-threatening Lesion in Left Orbit Complicated by Granulomatosis with Polyangiitis. Ocul Immunol Inflamm 2023; 31:1884-1886. [PMID: 36049048 DOI: 10.1080/09273948.2022.2115930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/17/2022] [Indexed: 10/14/2022]
Abstract
We present a unique case of acute on chronic left frontal sinusitis with an orbital abscess in the left orbit complicated by granulomatosis with polyangiitis and a defect to the structure of the orbit, among the 87 year old patient's other health-related conditions. Urgent transfer to tertiary care, and diagnostic, surgical, and multidisciplinary management were necessary to achieve a favorable clinical outcome: the eye was left undamaged and no infection spread to the brain. This report also sets out to review the literature.
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Affiliation(s)
- Iyad Majid
- Department of Ophthalmology, Martel Eye Medical Group, Rancho Cordova, California, USA
| | - James B Martel
- Department of Ophthalmology, Mercy San Juan Medical Center, Carmichael, California, USA
| | - Brandon Martel
- Department of Ophthalmology, California Northstate College of Medicine, Elk Grove, California, USA
| | - Melanie Martel
- Department of Ophthalmology, California Northstate College of Medicine, Elk Grove, California, USA
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2
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Raghavendra Prasad KU, Fida Harish AT. A Rare Presentation of Wegener's Granulomatosis in ENT. Indian J Otolaryngol Head Neck Surg 2023; 75:2363-2366. [PMID: 37636710 PMCID: PMC10447330 DOI: 10.1007/s12070-023-03653-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/27/2023] [Indexed: 08/29/2023] Open
Abstract
Wegener's granulomatosis or Granulomatosis with polyangiitis is a rare multisystem autoimmune vasculitis disease which may become life threatening due to the various system involvement. Granular hyperplastic gingivitis, the so called "strawberry gingivitis" is a rare manifestation of this disease, yet pathognomic when present. Early diagnosis and treatment is very important.
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Affiliation(s)
| | - A. T. Fida Harish
- Department of ENT, Hassan Institute of Medical sciences, Hassan, India
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3
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Labrador AJP, Valdez LHM, Marin NRG, Ibazetta KAR, Chacón JAL, Fernandez AJV, Valencia MSV, Marchant SW, Sanchez KBT, Villacrez C. Oral granulomatosis with polyangiitis a systematic review. Clin Exp Dent Res 2023; 9:100-111. [PMID: 36600477 PMCID: PMC9932239 DOI: 10.1002/cre2.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Granulomatosis with polyangiitis is an unusual multisystemic inflammatory disease, with vasculitis of small- and medium-sized vessels, with a predilection for upper lower airways and kidneys. The etiology remains unknown although it may originate from different stimuli, in genetically susceptible patients. MATERIALS AND METHODS A detailed database search was performed. The variables were demographics, localization, histopathological findings, antineutrophil cytoplasmic autoantibody, cytoplasmic (c-ANCA) tests, treatment, and follow-up. RESULTS Fifty-two cases were identified; the mean age was 49.6 years, with a range from 6 to 87 years. It was most frequently seen in females (57.7%). The most common race was white (59.6%). The most frequent location was in the maxillary gingiva (28.8%), followed by both the upper and lower gingiva (19.2%). The most common clinical presentation was "strawberry gingivitis" (61.5%). The main symptom was pain, in 50%. Regarding the c-ANCA test, it was positive in 71.2% of cases. The most common therapy was prednisone and cyclophosphamide, utilized in 51.9%. The average follow-up was 23.6 months, and 88.5% of patients were still alive at follow-up. CONCLUSION The diagnosis initially was difficult to establish, an early diagnosis and treatment are mandatory. If untreated the disease can be associated with morbidity and mortality. For the oral clinician, this disease needs to be addressed in the differential diagnosis of oral lesions.
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Affiliation(s)
- Alberto J. Peraza Labrador
- Centro de Odontologia IntegralAcariguaVenezuela
- Department of Diagnostic SciencesTexas A&M University School of DentistryTexasEstados Unidos
| | | | | | | | | | | | | | | | | | - Cesar A. Villacrez
- Dental Implant DepartmentUniversidad Señor de SIPAN Dental SchoolLimaPeru
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4
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Al-Sabbagh M, Hawasli A, Almehmadi N, Omami G, Miller CS. Hemorrhagic enlargement of the mandibular gingiva. J Am Dent Assoc 2023; 154:74-78. [PMID: 34836620 DOI: 10.1016/j.adaj.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 01/11/2023]
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5
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Tsai CH, Chen YK, Chen YF, Tseng CH. Oral granulomatosis with polyangiitis. J Dent Sci 2023; 18:451-452. [PMID: 36643218 PMCID: PMC9831807 DOI: 10.1016/j.jds.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 01/18/2023] Open
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6
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Oral Microbiota Profile in Patients with Anti-Neutrophil Cytoplasmic Antibody–Associated Vasculitis. Microorganisms 2022; 10:microorganisms10081572. [PMID: 36013990 PMCID: PMC9412476 DOI: 10.3390/microorganisms10081572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 02/01/2023] Open
Abstract
Microbiota has been associated with autoimmune diseases, with nasal Staphylococcus aureus being implicated in the pathogenesis of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Little is known about the role of oral microbiota in AAV. In this study, levels of IgG antibodies to 53 oral bacterial species/subspecies were screened using immunoblotting in plasma/serum in pre-symptomatic AAV-individuals (n = 85), matched controls, and established AAV-patients (n = 78). Saliva microbiota from acute-AAV and controls was sequenced from 16s rDNA amplicons. Information on dental status was extracted from a national register. IgG levels against oral bacteria were lower in established AAV versus pre-AAV and controls. Specifically, pre-AAV samples had, compared to controls, a higher abundance of periodontitis-associated species paralleling more signs of periodontitis in established AAV-patients than controls. Saliva microbiota in acute-AAV showed higher within-sample diversity but fewer detectable amplicon-sequence variants and taxa in their core microbiota than controls. Acute-AAV was not associated with increased abundance of periodontal bacteria but species in, e.g., Arthrospira, Staphylococcus, Lactobacillus, and Scardovia. In conclusion, the IgG profiles against oral bacteria differed between pre-AAV, established AAV, and controls, and microbiota profiles between acute AAV and controls. The IgG shift from a pre-symptomatic stage to established disease cooccurred with treatment of immunosuppression and/or antibiotics.
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7
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Subramanya AP, George JP, Prabhuji MLV, Bavle RM, Muniswamappa S. Granulomatosis with polyangiitis in gingiva: A rare case of isolated presentation. Intractable Rare Dis Res 2022; 11:93-95. [PMID: 35702581 PMCID: PMC9161130 DOI: 10.5582/irdr.2022.01045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/25/2022] [Accepted: 05/10/2022] [Indexed: 11/05/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease characterized by necrotising granulomatous inflammation of upper and lower respiratory tract, vasculitis and glomerulonephritis. This ailment may present with cough, haemoptysis, sinusitis, nasal deformity, skin lesions, malaise, fever, anorexia, and weight loss. Oral manifestation includes strawberry gingivitis, which is a pathognomonic clinical presentation. Here, we present a case of GPA in gingiva as the first manifestation. Clinical examination of the oral cavity revealed granular, erythematous gingival enlargement in the lower anterior teeth region involving papilla, marginal and attached gingiva with shiny and pebbled surface. Histopathological examination showed pseudoepitheliomatous hyperplasia with vasculitis and inflammation in the connective tissue, neutrophilic infiltration and abscess formation with haemorrhage were noted. Laboratory investigations revealed Proteinase 3 (PR3) antigen and Glomerular basement membrane (GBM) antigen were positive. Clinical, histopathological and laboratory investigations enabled the diagnosis of Granulomatosis with Polyangiitis. We present this rare case report of GPA with primary manifestation in gingiva.
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Affiliation(s)
- Ashwin Parakkaje Subramanya
- Department of Periodontology, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, India
- Address correspondence to:Ashwin Parakkaje Subramanya, Department of Periodontology, Krishnadevaraya College of Dental Sciences and Hospital, Sir MVIT Campus, Bengaluru 562157, Karnataka, India. E-mail:
| | - Joann Pauline George
- Department of Periodontology, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, India
| | | | - Radhika Manoj Bavle
- Department of Oral and Maxillofacial Pathology, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, India
| | - Sudhakar Muniswamappa
- Department of Oral and Maxillofacial Pathology, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, India
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8
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Steinke KV, Welkoborsky HJ. [Granulomatosis with polyangiitis - manifestations in the head and neck area]. Laryngorhinootologie 2021; 101:112-119. [PMID: 34781398 DOI: 10.1055/a-1580-7037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Granulomatosis with polyangiitis is a rare chronic rheumatologic systemic disease with a vasculitis of small- and medium-size vessels. Mostly the upper airways, lung and kidneys are affected. Symptoms are unspecific. Patients complain about stuffy nose, crustiness of nasal secretions, ulcera of the oral mucosa or epistaxis. The otorhinolaryngologist may be the first one to evaluate the patient's health condition. Long term complications may be cardial, renal or pulmonal failure. To this day the aetiology is still unknown. Severe disease is treated with a combination of immunosuppressive medications. Clinic examinations and laboratory tests should be carried out for life-time.
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9
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Alhassani AA, Al-Zahrani MS, Zawawi KH. Granulomatous diseases: Oral manifestations and recommendations. Saudi Dent J 2020; 32:219-223. [PMID: 32647468 PMCID: PMC7336012 DOI: 10.1016/j.sdentj.2019.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/25/2022] Open
Abstract
Granulomatous diseases may present with oral manifestations that are detectable by dental care providers. In certain cases, oral manifestations may precede systemic signs and symptoms. Dentists managing patients with these conditions may modify the dental treatment plan and possibly retain the support of other health professionals. This review gives an update on granulomatous diseases that can be faced by the dental practitioner.
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Affiliation(s)
- Ahmed A Alhassani
- Department of Periodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammad S Al-Zahrani
- Department of Periodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid H Zawawi
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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10
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de Castro TF, Tomo S, Santos-Silva AR, Bernabé DG, Biasoli ÉR, Crivelini MM, Okamoto AC, Miyahara GI. Granulomatous ulceration of the palate. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:390-394. [PMID: 32593618 DOI: 10.1016/j.oooo.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 04/21/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Tamara Fernandes de Castro
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil; Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Saygo Tomo
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil; Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, São Paulo, Brazil
| | - Daniel Galera Bernabé
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil; Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Éder Ricardo Biasoli
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil; Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Marcelo Macedo Crivelini
- Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Ana Cláudia Okamoto
- Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Glauco Issamu Miyahara
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil; Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil.
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11
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Dhalkari CD, Patil SC, Indurkar MS. Strawberry gingivitis - First sign of Wegener's granulomatosis. J Oral Maxillofac Pathol 2020; 24:172-175. [PMID: 32508469 PMCID: PMC7269271 DOI: 10.4103/jomfp.jomfp_3_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 09/06/2019] [Accepted: 09/24/2019] [Indexed: 11/25/2022] Open
Abstract
Wegener's Granulomatosis (WG) is an immunologically mediated rare multisystem disease characterized by necrotizing granulomatous inflammation affecting the upper and lower respiratory tracts, disseminated vasculitis and glomerulonephritis. WG oral lesions are reported to occur in 6%–13% of patients; they were an initial presenting feature in only 2% of cases. A case of strawberry gingivitis as the first sign of WG presented with erythematous and painful localized gingival enlargement affecting the maxillary anterior region of jaw in a 17-year-old boy is reported here. Correlation of histopathology with routine hematoxylin and eosin and special stains such as Grocott-Gomori's methenamine-silver nitrate and periodic acid–Schiff, peripheral blood smear, chest radiographs, Mantoux test and clinical presentation were established in diagnosing this rare entity. By the above-mentioned procedures, we arrived at the diagnosis of WG. The aim of reporting this case was to emphasize that, the dental surgeon often being the first person to examine the oral cavity, should be familiar with the typical appearance of gingiva as “strawberry gingivitis,” its clinical course, diagnostic parameters and adequate management of WG.
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Affiliation(s)
- Chandulal D Dhalkari
- Department of Periodontology and Implantology, Government Dental College and Hospital, Aurangabad, Maharashtra, India
| | - Sayali Chandrakant Patil
- Department of Periodontology and Implantology, Government Dental College and Hospital, Aurangabad, Maharashtra, India
| | - Maya S Indurkar
- Department of Periodontology and Implantology, Government Dental College and Hospital, Aurangabad, Maharashtra, India
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12
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Gingival Swelling as the Initial Manifestation of Granulomatosis with Polyangiitis. Head Neck Pathol 2020; 15:244-253. [PMID: 32096099 PMCID: PMC8010058 DOI: 10.1007/s12105-020-01144-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 12/30/2022]
Abstract
We describe a case of granulomatosis with polyangiitis (GPA; formerly named Wegener granulomatosis) that presented initially as florid areas of gingival swelling. The patient also had upper respiratory symptoms that included sinus congestion and cough of recent onset. Clinical-pathologic correlation aided the interpretation of non-specific biopsy findings and immediate referral to an appropriate medical specialist. Treatment was rendered at an early stage of disease with a good response to date. Review of the literature indicates that gingival swelling, often with the characteristic appearance of "strawberry gingivitis" may represent the initial sign of disease in 2% of patients with GPA. Biopsy of gingival lesions often shows a non-specific histologic appearance that should be interpreted in the context of the clinical appearance and pertinent medical history. The clinical investigations that lead to definitive diagnosis and treatment are presented to facilitate the management of this uncommon but potentially fatal condition.
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13
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Szczeklik K, Włudarczyk A, Wawrzycka-Adamczyk K, Górka J, Fuks-Kulska M, Darczuk D, Pytko-Polończyk J, Szczeklik W. Oral manifestations of granulomatosis with polyangiitis - Clinical and radiological assessment. J Dent Sci 2019; 14:54-60. [PMID: 30988880 PMCID: PMC6445982 DOI: 10.1016/j.jds.2018.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/04/2018] [Indexed: 12/19/2022] Open
Abstract
Background/purpose Granulomatosis with polyangiitis (GPA) is a type of primary systemic vasculitis associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA). GPA mainly affects medium and small vessels and may manifest in different organs, most commonly upper respiratory tract. Oral lesions occur in 6–13% of GPA patients and might be the first symptom observed by the patient. This study presents the evaluation of orofacial manifestations of patients with GPA. Materials and methods Prospective study was conducted between June 2014 and November 2017 in Department of Allergy and Immunology at University Hospital in Krakow. Patients diagnosed with GPA, after medical assessment, were examined including precise dental inspection, bacterial and fungal flora of oral cavity evaluation and Cone Beam Computed Tomography (CBCT) imaging. Results Nine patients were enrolled in the study. Characteristic for GPA strawberry gingivitis was observed in one patient. Bone destruction and inflammatory lesions in paranasal sinuses was confirmed by CBCT in 55.6% of patients. Fungal infection was revealed in 66.7% of patients. Conclusion These findings oblige dentists to consult patient with laryngologist or internal medicine physician to establish further diagnostic approach, because early diagnosis of GPA is crucial for implementing appropriate treatment and preventing chronic organ damage.
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Affiliation(s)
- Katarzyna Szczeklik
- Department of Integrated Dentistry, Institute of Dentistry, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Włudarczyk
- 2nd Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Jacek Górka
- 2nd Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Dagmara Darczuk
- Department of Periodontology and Clinical Oral Pathology Institute of Dentistry, Jagiellonian University Medical College, Krakow, Poland
| | - Jolanta Pytko-Polończyk
- Department of Integrated Dentistry, Institute of Dentistry, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Szczeklik
- 2nd Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Abstract
Vasculitis is an inflammatory condition that targets the blood vessels, which may occur in isolation or as a component of a systemic inflammatory condition. Although many of the vasculitides can directly affect the organs of the gastrointestinal system, some types exhibit a proclivity for certain gastrointestinal and hepatic organs. Often a patient presents with nonspecific symptoms, delaying the diagnosis and treatment of the underlying vasculitis. Vasculitis can also present with severe manifestations, such as upper gastrointestinal bleeds and bowel perforation. It is important to identify the signs and symptoms of vasculitis in gastrointestinal system and institute appropriate treatment.
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Affiliation(s)
- Eric Anderson
- Denver Veterans Affairs Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Neel Gakhar
- Denver Veterans Affairs Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Courtney Stull
- Denver Veterans Affairs Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Liron Caplan
- Denver Veterans Affairs Medical Center, University of Colorado School of Medicine, Denver, CO, USA.
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15
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Reddy BVR, Kuruba KK, Yalamanchili S, Mupparapu M. Granulomatous Diseases Affecting Jaws. Dent Clin North Am 2017; 60:195-234. [PMID: 26614955 DOI: 10.1016/j.cden.2015.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The common aspect of all granulomatous diseases is the typical form of chronic inflammatory response with distinct microscopic granulomas that are formed secondary to either definitive etiologic agents, like bacteria, fungal, or parasitic, or due to an unknown etiologic agent, such as trauma, autoimmune, or even neoplastic process. Although they can be histologically distinct, granulomatous diseases demonstrate a variety of clinical features that may not seem to be inflammatory. Two types of granulomas are typically encountered: foreign body granulomas and immune granulomas. The differences between the two types of granulomas lie in the pathogenesis.
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Affiliation(s)
- Baddam Venkat Ramana Reddy
- Department of Oral & Maxillofacial Pathology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, 522601, India
| | - Kiran K Kuruba
- Department of Oral & Maxillofacial Pathology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, 522601, India
| | - Samatha Yalamanchili
- Department of Oral Medicine & Radiology, Sibar Institute of Dental Sciences, Guntur, India
| | - Mel Mupparapu
- Department of Oral Medicine, Robert Schattner Center, University of Pennsylvania School of Dental Medicine, #214, 240 South 40th Street, Suite 214, Philadelphia, PA 19104, USA.
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16
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Prasetyo D, Johnson P. Not quite strawberry gingivitis. Intern Med J 2017; 47:227-228. [PMID: 28201862 DOI: 10.1111/imj.13322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/22/2016] [Accepted: 05/22/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Davin Prasetyo
- Rehabilitation and Aged Care Department, Hornsby-Ku-Ring-Gai Hospital, Sydney, New South Wales, Australia
| | - Peter Johnson
- General Medicine Department, Hawkesbury Hospital, Sydney, New South Wales, Australia
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17
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Bowers L, Brennan M. Oral Complications of Multiorgan Disorders. Atlas Oral Maxillofac Surg Clin North Am 2017; 25:187-195. [PMID: 28778307 DOI: 10.1016/j.cxom.2017.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Leah Bowers
- Oral and Maxillofacial Surgery, UCSF School of Dentistry, 533 Parnassus Avenue, PO Box 0404, UB-10, San Francisco, CA 94143, USA.
| | - Michael Brennan
- Department of Oral Medicine, Carolinas Medical Center, Carolinas HealthCare System, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA
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18
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Fonseca FP, Benites BM, Ferrari A, Sachetto Z, de Campos GV, de Almeida OP, Fregnani ER. Gingival granulomatosis with polyangiitis (Wegener's granulomatosis) as a primary manifestation of the disease. Aust Dent J 2016; 62:102-106. [PMID: 27439744 DOI: 10.1111/adj.12441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2016] [Indexed: 01/20/2023]
Abstract
Granulomatosis with polyangiitis (GPA) is a potentially lethal disease characterized by systemic necrotizing vasculitis, which affects small- and medium-sized blood vessels and is often associated with serum cytoplasmic antineutrophil cytoplasmic antibody. The upper and lower respiratory tract and kidney are the most involved sites, but oral lesions can be identified in 6-13% of the cases, whereas in only 2% of the cases, oral manifestations represent the first signal of the disease usually as gingival swellings or unspecific ulcerations. Without treatment, the mainstay of which is the combination of immunosuppressants and systemic corticosteroids, GPA may run a fatal course. In this report we describe an original case of GPA affecting a 75-year-old female patient referred to our service due to a gingival swelling with 3-month duration. Although the patient was correctly diagnosed and promptly treated, she died 3 months after the initial diagnosis.
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Affiliation(s)
- F P Fonseca
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - B M Benites
- Oral Medicine Department, Sírio-Libanês Hospital, São Paulo, Brazil
| | - Alv Ferrari
- Department of Rheumatology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Z Sachetto
- Department of Rheumatology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - O P de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - E R Fregnani
- Oral Medicine Department, Sírio-Libanês Hospital, São Paulo, Brazil
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19
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Hamburger J. Orofacial manifestations in patients with inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:826-850. [PMID: 27964791 DOI: 10.1016/j.berh.2016.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/19/2016] [Indexed: 11/16/2022]
Abstract
The main orofacial manifestation of the inflammatory rheumatic diseases is that of Sjögren's syndrome. In addition, there is a constellation of orofacial manifestations of the inflammatory rheumatic diseases, many of which are extra-articular with some constituting presenting signs of the underlying rheumatic disease. This review will discuss the orofacial manifestations in a variety of connective tissue diseases and will also allude to the oral adverse drug reactions that may occur as a consequence of therapy.
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Affiliation(s)
- John Hamburger
- Birmingham Behçet's Syndrome Centre of Excellence, Sheldon Block, Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham, B18 7QH, UK.
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Lanzel E, Syrbu SI, Hellstein JW, Stein KM, Welander S, Sousa Melo SL. Destructive soft tissue mass in the maxilla/maxillary sinus. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 125:510-515. [PMID: 28089462 DOI: 10.1016/j.oooo.2016.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/18/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Emily Lanzel
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA.
| | - Sergei I Syrbu
- Department of Pathology, Caver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - John W Hellstein
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Kyle M Stein
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Sean Welander
- Division of Oral and Maxillofacial Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Saulo L Sousa Melo
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
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Hanisch M, Fröhlich LF, Kleinheinz J. Gingival hyperplasia as first sign of recurrence of granulomatosis with polyangiitis (Wegener's granulomatosis): case report and review of the literature. BMC Oral Health 2016; 17:33. [PMID: 27485511 PMCID: PMC4969735 DOI: 10.1186/s12903-016-0262-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Granulomatosis with polyangiitis (GPA), formerly referred to as Wegener's granulomatosis, is a rare systemic disease of unknown etiology which can affect all areas of the body, including the oral cavity. The typical oral manifestations occur as nonspecific erosive/ulcerative lesions of the oral cavity or appear with hyperplastic gingivitis, a so called "strawberry gingivitis". CASE PRESENTATION We report here about an extremely rare case with hyperplastic gingivitis as the first sign of recurrence of GPA in the absence of oral manifestations in the primary disease. A 72 year-old female was referred to our Department of Cranio-Maxillofacial Surgery with hyperplastic gingivitis. The patient was diagnosed with GPA already eight years before. We referred the patient to our Clinic of Internal Medicine where she was successfully treated with rituximab. At the follow-up visit, the patient showed complete remission of the hyperplastic gingiva. CONCLUSION The often overlooked oral manifestation may be interpreted as the first evidence of resurgent GPA in general and therefore could be pathognostic for the disease. This case affirms the need of health professionals to be acquainted with orofacial manifestations of rare diseases such as GPA. As a consequence, dentists will be able to assist in diagnosing GPA more easily leading to a better prognosis for patients suffering from this disease.
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Affiliation(s)
- Marcel Hanisch
- Department of Cranio-Maxillofacial Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude W 30, D-48149 Münster, Germany
| | - Leopold F. Fröhlich
- Department of Cranio-Maxillofacial Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude W 30, D-48149 Münster, Germany
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude W 30, D-48149 Münster, Germany
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Sibaud V, Vigarios E, Tavitian S, Cougoul P, de Bataille C, Campana F, Fricain JC. [Gingival enlargement: Practical management]. Ann Dermatol Venereol 2016; 143:467-81. [PMID: 27259395 DOI: 10.1016/j.annder.2016.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 03/20/2016] [Accepted: 04/01/2016] [Indexed: 12/27/2022]
Affiliation(s)
- V Sibaud
- Oncodermatologie, consultation pluridisciplinaire de pathologies de la muqueuse buccale, institut Claudius-Regaud, institut universitaire du cancer, Toulouse oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
| | - E Vigarios
- Médecine bucco-dentaire, consultation pluridisciplinaire de pathologies de la muqueuse buccale, institut Claudius-Regaud, institut universitaire du cancer, Toulouse oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France; UFR d'odontologie, 3, rue des Maraîchers, 31062 Toulouse, France
| | - S Tavitian
- Hématologie, institut universitaire du cancer, Toulouse oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - P Cougoul
- Médecine interne, institut universitaire du cancer, Toulouse oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - C de Bataille
- Médecine bucco-dentaire, consultation pluridisciplinaire de pathologies de la muqueuse buccale, institut Claudius-Regaud, institut universitaire du cancer, Toulouse oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France; UFR d'odontologie, 3, rue des Maraîchers, 31062 Toulouse, France
| | - F Campana
- Chirurgie orale, centre Massilien de la face, 24, avenue du Prado, 13006 Marseille, France
| | - J-C Fricain
- Chirurgie orale, consultation pluridisciplinaire de pathologies de la muqueuse buccale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; UFR d'odontologie, 16-20, cours de la Marne, 33082 Bordeaux cedex, France
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23
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[Chronic or recurrent ulceration of the tongue]. Ann Dermatol Venereol 2016; 143:297-308; quiz 295-6, 309-10. [PMID: 27038855 DOI: 10.1016/j.annder.2016.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/31/2016] [Accepted: 02/04/2016] [Indexed: 11/23/2022]
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24
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Sung IY, Kim YM, Cho YC, Son JH. Role of gingival manifestation in diagnosis of granulomatosis with polyangiitis (Wegener's granulomatosis). J Periodontal Implant Sci 2015; 45:247-51. [PMID: 26734495 PMCID: PMC4698952 DOI: 10.5051/jpis.2015.45.6.247] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/27/2015] [Indexed: 11/22/2022] Open
Abstract
Purpose This report describes a case of granulomatosis with polyangiitis (GPA) in which the gingival manifestation was crucial in both making an early diagnosis and possibly in deciding the approach to treatment. Methods A 57-year-old sailor presented to the Department of Dentistry at Ulsan University Hospital complaining of gingival swelling since approximately 2 months. He had orofacial granulomatous lesions and the specific gingival manifestation of strawberry gingivitis. Results The diagnosis of GPA was made on the basis of clinical symptoms and signs, and confirmed by the presence of the anti-neutrophil cytoplasmic antibody and a positive biopsy. The patient was admitted to the hospital and subsequently placed on a disease-modifying therapy regimen that included methotrexate and prednisone. Conclusions Identification of the gingival manifestation of the disease permitted an early diagnosis and prompt therapy in a disease in which time is a crucial factor. Because of its rapid progression and potentially fatal outcome, an early diagnosis of GPA is important. Therefore, dentists should be aware of the oral signs and symptoms of such systemic diseases.
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Affiliation(s)
- Iel-Yong Sung
- Department of Dentistry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young-Min Kim
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yeong-Cheol Cho
- Department of Dentistry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jang-Ho Son
- Department of Dentistry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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25
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Troiano G, Dioguardi M, Giannatempo G, Laino L, Testa NF, Cocchi R, De Lillo A, Lo Muzio L. Orofacial granulomatosis: clinical signs of different pathologies. Med Princ Pract 2015; 24:117-22. [PMID: 25592641 PMCID: PMC5588207 DOI: 10.1159/000369810] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 11/11/2014] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Giuseppe Troiano
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Mario Dioguardi
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Giovanni Giannatempo
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Luigi Laino
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | | | - Roberto Cocchi
- Unit of Maxillofacial Surgery, Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
| | - Alfredo De Lillo
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
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Almouhawis HA, Leao JC, Fedele S, Porter SR. Wegener's granulomatosis: a review of clinical features and an update in diagnosis and treatment. J Oral Pathol Med 2013; 42:507-16. [PMID: 23301777 DOI: 10.1111/jop.12030] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2012] [Indexed: 01/31/2023]
Abstract
Wegener's granulomatosis (WG) is an idiopathic, systemic inflammatory disease characterized by necrotizing granulomatous inflammation and pauci-immune small-vessel vasculitis of upper and lower respiratory tract and kidneys. The condition affects both genders equally, although some inconsistent gender differences have been observed. The aetiology of WG remains unknown although a number of exogenous factors have been suggested to be of aetiological relevance. Most clinical characteristics of this disease are non-specific, making clinical diagnosis challenging. Histopathological examination of lesional and peritoneal tissue is not pathognomonic, but is an essential investigation to confirm the presence of disease and exclude other disorders. At present, despite the increasingly wide range of potential therapies, cyclophosphamide plus corticosteroids remain the most recognized and effective means of inducing and sustaining remission of WG.
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Affiliation(s)
- Hanan A Almouhawis
- Oral Medicine unit, Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, London, UK
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28
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A 57-year-old man with inflamed, enlarged gingivae and associated bone loss. J Am Dent Assoc 2012; 143:43-6. [DOI: 10.14219/jada.archive.2012.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Woo SB. Immune-Mediated, Autoimmune, and Granulomatous Conditions. ORAL PATHOLOGY 2012:150-184. [DOI: 10.1016/b978-1-4377-2226-0.00008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Xing X, Zhang T, Wang X. Pediatric Wegener's granulomatosis with oral ulcers and progressive periodontitis: a case report. ACTA ACUST UNITED AC 2011; 112:e1-5. [PMID: 21868265 DOI: 10.1016/j.tripleo.2011.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 05/23/2011] [Accepted: 05/24/2011] [Indexed: 10/17/2022]
Abstract
Wegener's granulomatosis (WG) is a rare multisystem disorder. Although it can occur at any age, it is rarely observed in children. Oral manifestations, which are present in fewer than 10% of patients, include oral ulceration, nonhealing extraction sockets, and the most common oral lesion, hyperplastic gingivitis, which is known as "strawberry gingivitis." We report the unusual case of a 6-year-old boy with WG who presented with atypical oral manifestations, including severe progressive periodontitis accompanied by oral ulcers, before the development of systemic symptoms. Although WG is rare, this case emphasizes the importance of considering the diagnosis in those who present with progressive and atypical oral disease, as prompt treatment of the systemic illness can significantly improve outcome.
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Affiliation(s)
- Xianghui Xing
- School of Stomatology, Fourth Military Medical University, Xi'an, China
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31
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Siar CH, Yeo KB, Nakano K, Nagatsuka H, Tsujigiwa H, Tomida M, Ng KH, Kawakami T. Strawberry gingivitis as the first presenting sign of Wegener's granulomatosis: report of a case. Eur J Med Res 2011; 16:331-4. [PMID: 21813375 PMCID: PMC3352006 DOI: 10.1186/2047-783x-16-7-331] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Wegener's granulomatosis is a rare multi-system disease characterized by the classic triad of necrotizing granulomas affecting the upper and lower respiratory tracts, disseminated vasculitis and glomerulonephritis. Oral lesions as a presenting feature are only encountered in 2% of these cases. Hyperplastic gingival lesions or strawberry gingivitis, is a characteristic sign of Wegener's granulomatosis. The latter consists of reddish-purple exophytic gingival swellings with petechial haemorrhages thus resembling strawberries. Recognition of this feature is of utmost importance for timely diagnosis and definitive management of this potentially fatal disease. A case of strawberry gingivitis as the first presenting sign of Wegener's granulomatosis affecting a 50-year-old Malay male is reported here. The differential diagnosis of red lesions that may present in the gingiva is discussed.
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Affiliation(s)
- C H Siar
- Department of Oral Pathology, Oral Medicine and Periodontology, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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Staines KS, Higgins B. Recurrence of Wegener's granulomatosis with de novo intraoral presentation treated successfully with rituximab. ACTA ACUST UNITED AC 2009; 108:76-80. [PMID: 19451001 DOI: 10.1016/j.tripleo.2009.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 02/05/2009] [Accepted: 02/08/2009] [Indexed: 10/20/2022]
Abstract
We describe a unique case of a recurrence of Wegener's granulomatosis (WG) that presented with oral pain involving a left maxillary molar, which thereafter led to an extraction. Oral lesions with a classical appearance of strawberry gingivitis developed following the extraction. The primary disease did not have any oral manifestations. Both the primary disease and recurrence responded to rituximab, a monoclonal B-cell depleting antibody. Rituximab is emerging as a drug with significant potential to improve treatment of primary and, as described in this case, recurrent WG.
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Compilato D, Cirillo N, Termine N, Kerr AR, Paderni C, Ciavarella D, Campisi G. Long-standing oral ulcers: proposal for a new `S-C-D classification system’. J Oral Pathol Med 2008; 38:241-53. [PMID: 19141062 DOI: 10.1111/j.1600-0714.2008.00722.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Horino T, Takao T, Taniguchi Y, Terada Y. Non-infectious endocarditis in a patient with cANCA-associated small vessel vasculitis. Rheumatology (Oxford) 2008; 48:592-4. [DOI: 10.1093/rheumatology/kep017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hernández G, Serrano C, Porras L, Lopez-Pintor R, Rubio L, Yanes J. Strawberry-Like Gingival Tumor as the First Clinical Sign of Wegener's Granulomatosis. J Periodontol 2008; 79:1297-303. [DOI: 10.1902/jop.2008.070572] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Neville BW. Update on current trends in oral and maxillofacial pathology. Head Neck Pathol 2007; 1:75-80. [PMID: 20614286 PMCID: PMC2807501 DOI: 10.1007/s12105-007-0007-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 06/19/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Brad W. Neville
- Division of Oral Pathology, College of Dental Medicine, Medical University of South Carolina, 173 Ashley Avenue, P.O. Box 250507, Charleston, SC 29425 USA
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40
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Ettl T, Pistner H, Schwarz S, Reichert TE, Driemel O. [Foudroyant course of a therapy resistent Wegener's granulomatosis with negative c-ANCA]. ACTA ACUST UNITED AC 2007; 11:73-80. [PMID: 17406921 DOI: 10.1007/s10006-007-0052-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 02/20/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Wegener's Granulomatosis is a rare systemic disease characterized by the triad of necrotizing granulomas of blood vessels, upper respiratory tract, and kidneys. Diagnosis depends on clinical symptoms (ACR-criteria), detection of serum circulating antineutrophil cytoplasmic antibodies (c-ANCA) and bioptical histopathology. CASE-REPORT A 34-year-old patient presented with intraoral ulcerating, necrotizing inflammations of the palate and the gingiva. Chest radiograph (nodules, infiltrates), urin analysis (red blood cell casts) being inconspicuous Wegener's granulomatosis was diagnosed by histopathology of an intraoral incisional biopsy. Conventional therapy with corticosteroids and cyclophosphamide relapsed while the disease was taking a progressive course (pulmonary infiltrates, necrotizing vasculitides all over the common integument). The patient died of cardiac decompensation three months after diagnosis. c-ANCAs were not present at any time of disease. CONCLUSIONS 1. Symptoms of the head and neck are manifest in up to 95% of Wegener's granulomatosis. So knowledge of the disease is important for dentists and oral and maxillofacial surgeons in spite of its low prevalence. 2. c-ANCA-titers do not reflect disease activity. Negative c-ANCAs do not exclude Wegener's granulomatosis. 3. Wegener's granulomatosis can take a progressive, therapy resistent course.
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Affiliation(s)
- T Ettl
- Universität Regensburg, Klinik und Poliklinik für Mund, Kiefer- und Gesichtschirurgie, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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