Diagnosis of sarcoidosis from oral manifestation

A Rare Presentation of Intraosseous Sarcoidosis of the Mandible Presenting as Peri-Implantitis: A Case Report and Literature Review

PURPOSE

We describe a rare case of intraosseous sarcoidosis initially presenting as peri-implantitis, perform a review and analysis of 27 cases of intraosseous sarcoidosis, and provide a clinical review of this condition.

METHODS

We searched the literature for patients presenting with intraosseous sarcoidosis of the jaw through June 2020 using key phrases. Additional papers were included via a search of references and citing papers. Data including patient demographic characteristics and diagnostic tests were manually extracted from the cases and then qualitatively coded by the authors. Descriptive statistical analysis was performed to elucidate general themes and characteristics.

RESULTS

A total of 27 cases, dating as early as 1943 and as recent as this case, were identified in the literature, including our case. The average age of these patients was 39 years old, with a range of 16 to 75 years. Eighteen (67%) cases were identified as female and nine (33%) as male. Fourteen cases were reported with localized mandibular involvement. Ten had maxillary disease; 3 cases were generalized to both regions. Nine cases presented anteriorly, 12 posteriorly, and 6 extended across both regions. Eight patients received surgical interventions, such as tooth extractions or lesion removal. Five patients received nonsurgical interventions, such as steroids. Ten patients received combination therapy, often involving surgical intervention and steroid therapy.

CONCLUSION

Our patient had an unusual presentation of intraosseous sarcoidosis mimicking peri-implantitis. To our knowledge, no case in the English literature describes a patient with sarcoidosis presenting with peri-implantitis. Based on the literature review and analysis of our patient's experience, sarcoidosis should be considered on the differential diagnosis for patients with persistent, nonhealing bony lesions in the maxillofacial region, particularly when patients have not been exposed to osteoclast inhibitory therapy or radiation. Pathologic analysis of bone and surrounding tissue in these scenarios is essential.

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.

Sarcoidosis of the submandibular gland: A systematic review

INTRODUCTION

Submandibular gland sarcoidosis is rare and little is known about its clinical presentation besides the usual neck swelling. The aim of the study was to extract clinical knowledge on submandibular sarcoidosis from the literature.

METHODS

A systematic review was performed using a search in Medline with the key-words "sarcoidosis," "submandibular," "submaxillary."

RESULTS

Forty-six articles fitting the search criteria were found, whereas 31 had to be excluded because they did not report submandibular gland sarcoidosis. Twenty cases of submandibular gland sarcoidosis were considered suitable for analysis. Almost all reported cases concerned female patients. In some cases submandibular gland's swelling is the first and only manifestation of the disease.

CONCLUSION

Sarcoidosis should be considered in the differential diagnosis of all progressive and painless swellings of the submandibular gland, especially in women. Rarely, it may be the first manifestation of the disease.

Diagnosis of systemic sarcoidosis prompted by orofacial manifestations

BACKGROUND

Sarcoidosis is a multifactorial systemic inflammatory disorder of unknown origin characterized by many potential signs and symptoms, as well as by the presence of noncaseating granulomas in the organs involved. Sarcoidosis also may manifest in the oral and maxillofacial region.

CASE DESCRIPTION

The authors describe a patient with xerostomia, dysgeusia, oral burning, xerophthalmia and bilateral parotid enlargement. She was diagnosed as having systemic sarcoidosis on the basis of the histologic findings of a biopsy of the labial minor salivary gland, as well as subsequent diagnostic evalutons.

CONCLUSION AND CLINICAL IMPLICATIONS

Enlargement of major salivary glands may be the first sign of sarcoidosis in a patient with few other symptoms or clinical findings suggestive of the disease. This case emphasizes the importance of including sarcoidosis in the differential diagnosis of bilateral parotid swelling associated with xerostomia. It also highlights the dentist's potential role in the diagnosis and dental treatment of patients with systemic sarcoidosis.

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.

Intraosseous sarcoidosis of the jaws mimicking aggressive periodontitis: a case report and literature review

BACKGROUND

Sarcoidosis is a relatively common systemic granulomatous disease of unknown etiology. The skeletal system is affected in up to 39% of patients, but intraosseous sarcoidosis affecting the maxilla and mandible is rare. Only 20 cases have been reported previously in the English literature. This paper presents a case of generalized intraosseous sarcoidosis of the jaw bones that mimicked rapidly progressive periodontitis.

METHODS

A 46-year-old male patient presented with loose teeth for assessment of implants. He had been gradually losing his teeth since 1999. His past medical history was significant, with sarcoidosis diagnosed in 1998. A panoramic radiograph showed a bilateral cotton-wool appearance of the mandible. A soft tissue and bone biopsy was performed and sent for histological examination.

RESULTS

Microscopic examination of hematoxylin and eosin-stained sections revealed non-caseating granulomatous inflammation consistent with skeletal sarcoidosis.

CONCLUSIONS

Intraosseous sarcoidosis of the jaw bones is rare and presents commonly as progressive and rapid alveolar bone loss similar to periodontitis. Therefore, it is important for periodontists to be knowledgeable and able to diagnose this condition, as rapid alveolar bone loss may be the first sign of sarcoidosis.

Nonpainful swelling of the palate and loosening of the maxillary incisors

Bone lesions in the maxilla have rarely been described in relation to sarcoidosis. This patient exhibited many of the classic signs of sarcoidosis, including lack of symptoms at the time of presentation, which resulted in the diagnosis of sarcoidosis being made serendipitously. The presence of musculoskeletal lesions is often regarded as a poor prognostic sign and, in general, sarcoidosis follows a more virulent course in black patients. Sadly, the course of the disease in this patient continues to march onward despite a 1-year therapeutic trial of corticosteroids.

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.

Treating oral sarcoidosis

Oral sarcoidosis is rare and can be confused with various other lesions. Two case reports of sarcoidosis involving the lips are presented along with a discussion of sarcoidosis and treatment options.

Sarcoidosis. Report of two cases with oral involvement

Sarcoidosis is a multisystem granulomatous disease in which pulmonary involvement is the most characteristic feature. Even though extrapulmonary manifestations occur infrequently in the area of the head and neck an occasional patient will have oral involvement. As we will demonstrate in these case reports, sarcoidosis should be included in the differential diagnosis of oral and perioral papular lesions noted on examinations of the head and neck.

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.

Multisystem sarcoid presenting with gingival hyperplasia

A case is reported in which granulomatous gingival hyperplasia was the presenting feature of generalised sarcoidosis. Treatment with oral prednisolone resulted in resolution of both the granulomatous lesion of the gums, and of proteinuria. It is pointed out that although on histological examination sarcoidosis in this site cannot be distinguished from Crohn's disease, the clinical appearance in this patient (and the only similar case in the literature) was quite different from that seen in oral Crohn's disease.

Systemic sarcoidosis presenting with Horner's syndrome and mandibular paresthesia

A patient with Stage I systemic sarcoid (affecting the mediastinum and cervical lymph nodes) is presented. This patient had ptosis of the eyelid and miosis (Horner's syndrome) due to involvement of the cervical-thoracic sympathetic nerves by the granulomatous process. Bony destruction simulating periodontal disease occurred in the molar-premolar region and caused pain and paresthesia. Systemic sarcoid may occur more commonly in the jaws than reported cases would indicate. Sarcoidosis should be considered in the differential diagnosis when periodontal disease appears refractory to local therapy.