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Wang Y, Xu H, Wei M, Wang Y, Wang W, Ju J, Liu Y, Wang X. Identification of Putative Bacterial Pathogens for Orofacial Granulomatosis Based on 16S rRNA Metagenomic Analysis. Microbiol Spectr 2023; 11:e0226622. [PMID: 37227290 PMCID: PMC10269498 DOI: 10.1128/spectrum.02266-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
Orofacial granulomatosis (OFG) is a chronic inflammatory disease characterized by nontender swelling of the orofacial tissues, the underlying cause of which remains unknown. Our previous study demonstrated that tooth apical periodontitis (AP) is involved in the development of OFG. To characterize the AP bacterial signatures of OFG patients and identify possible pathogenic bacteria that cause OFG, the compositions of the AP microbiotas in OFG patients and controls were compared using 16S rRNA gene sequencing. Pure cultures of putative bacterial pathogens were established by growing bacteria as colonies followed by purification, identification, and enrichment and then were injected into animal models to determine the causative bacteria contributing to OFG. A specific AP microbiota signature in the OFG patients was shown, characterized by the predominance of phyla Firmicutes and Proteobacteria, notably members of the genera Streptococcus, Lactobacillus, and Neisseria, were found. Streptococcus spp., Lactobacillus casei, Neisseria subflava, Veillonella parvula, and Actinomyces spp. from OFG patients were isolated and successfully cultured in vitro and then injected into mice. Ultimately, footpad injection with N. subflava elicited granulomatous inflammation. IMPORTANCE Infectious agents have long been considered to play a role in the initiation of OFG; however, a direct causal relationship between microbes and OFG has not yet been established. In this study, a unique AP microbiota signature was identified in OFG patients. Moreover, we successfully isolated candidate bacteria from AP lesions of OFG patients and assessed their pathogenicity in laboratory mice. Findings from this study may help provide in-depth insights into the role of microbes in OFG development, providing the basis for targeted therapeutic approaches for OFG.
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Affiliation(s)
- Yuanyuan Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi’an, China
- Shaanxi Clinical Research Center for Oral Diseases, the National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology, Xi’an, China
| | - Hao Xu
- Shaanxi Key Laboratory of Brain Disorders & School of Basic Medical Sciences, Xi'an Medical University, Xi’an, China
| | - Minghui Wei
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi’an, China
- Shaanxi Clinical Research Center for Oral Diseases, the National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology, Xi’an, China
| | - Yuhong Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi’an, China
- Shaanxi Clinical Research Center for Oral Diseases, the National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology, Xi’an, China
| | - Wenzhe Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi’an, China
- Shaanxi Clinical Research Center for Oral Diseases, the National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology, Xi’an, China
| | - Jia Ju
- Shaanxi Clinical Research Center for Oral Diseases, the National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology, Xi’an, China
- Department of Pharmacy, School of Stomatology, the Fourth Military Medical University, Xi’an, China
| | - Yuan Liu
- Shaanxi Clinical Research Center for Oral Diseases, the National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology, Xi’an, China
- Department of Oral Histology and Pathology, School of Stomatology, the Fourth Military Medical University, Xi’an, China
| | - Xinwen Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi’an, China
- Shaanxi Clinical Research Center for Oral Diseases, the National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology, Xi’an, China
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2
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Sitenga G, Granger P, Marvin E, Anderson K, Davis D, Hand J, Tollefson M. Granulomatous cheilitis in children: three cases successfully treated with intralesional corticosteroids. Int J Dermatol 2023; 62:e238-e239. [PMID: 35385127 DOI: 10.1111/ijd.16201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/05/2021] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Peter Granger
- Creighton University School of Medicine, Omaha, NE, USA
| | | | - Katelyn Anderson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dawn Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jennifer Hand
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Megha Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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3
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Joshi S, Mawdsley J, Hullah E, Ormond M, Carey B. Management of orofacial granulomatosis. Br J Hosp Med (Lond) 2023; 29:1-16. [PMID: 36989148 DOI: 10.12968/hmed.2022.0416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Orofacial granulomatosis is a chronic relapsing-remitting inflammatory condition that shares a similar phenotypic presentation to some other granulomatous diseases, particularly Crohn's disease. However, subtle clinical and pathological differences justify it as a separate disease entity. Previous studies have assessed the effectiveness of interventions used in the management of orofacial granulomatosis. This article reviews the management options available. A literature search was conducted to identify studies, in English, which assessed the effect of non-pharmacological and pharmacological interventions in the treatment of orofacial granulomatosis. The interventions were categorised into dietary modification, pharmacological (topical, intralesional and systemic therapy), surgery and psychological. A combination of interventions is often required to effectively manage each patient. There is convincing evidence that diet plays a role in disease severity. In patients where dietary manipulation alone is unsuccessful, topical, intralesional and/or systemic treatment may be considered to manage the condition.
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Affiliation(s)
- Sandeep Joshi
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joel Mawdsley
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Esther Hullah
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Martyn Ormond
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Barbara Carey
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
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4
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Wenda N, Stuhrmann NC, Messerschmid A, Märker‐Hermann E, Gosepath J. Melkersson‐Rosenthal‐syndrome ‐ A Rare Case of Laryngeal Involvement. Laryngoscope 2022; 132:2442-2444. [DOI: 10.1002/lary.30311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Nina Wenda
- Department of Otolaryngology Head and Neck Surgery, Helios HSK Wiesbaden Germany
| | - Nicole Christina Stuhrmann
- Department of Otolaryngology Head and Neck Surgery, Helios HSK Wiesbaden Germany
- Phoniatrics and Pediatric Audiology Head and Neck Surgery, Helios HSK Wiesbaden Germany
| | - Anna Messerschmid
- Department of Otolaryngology Head and Neck Surgery, Helios HSK Wiesbaden Germany
| | | | - Jan Gosepath
- Department of Otolaryngology Head and Neck Surgery, Helios HSK Wiesbaden Germany
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5
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Cooper K, Bovis J, Gordon K, Milroy CM. Intra-lesional Corticosteroids and Diathermy Ablation for the Management of Anogenital Granulomatosis: A Retrospective Cohort Study. Clin Exp Dermatol 2022; 47:1679-1685. [PMID: 35546092 DOI: 10.1111/ced.15259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anogenital Granulomatosis (AGG) is a rare, chronic condition that presents in males and females with progressive inflammation and lymphoedema of the anogenital region. No guidelines exist for its management. Systemic immunosuppressants are the current cornerstone of medical therapy for AGG but results from small-numbered case series have reported variable responses. OBJECTIVE This study aimed to investigate whether intra-lesional corticosteroid injections +/- diathermy ablation provided effective control of symptoms over a 6-month period in patients diagnosed with AGG. METHODS This retrospective observational cohort study included 11 patients with AGG consecutively treated with ILC+/-DA at a single centre. The primary outcome was defined as a statistically significant decrease in mean disease severity score, at both 1- and 6-months post treatment. The secondary outcome was a statistically significant association between reduction in disease severity score at 6 months post-treatment and potentially confounding factors. Wilcoxon sign-ranked tests and ordinal logistic regression analysis were applied to assess the data. Ancillary outcomes are also reported including whether patients experienced adverse effects post-treatment and if patients experienced recurrence at any point beyond 6 months post-treatment. RESULTS Compared to pre-treatment disease severity scores, there was a statistically significant decrease in disease severity scores at both 1- and 6-months post treatment (p = 0.01). No significant association was found between identified confounding factors and reduction in disease severity score at 6 months post-treatment. One patient experienced an episode of cellulitis within a week of treatment. 5 patients never experienced a recurrence of symptoms post-treatment, with a mean follow up period of 28 months post-treatment. All 6 patients who did experience recurrence of symptoms reported symptoms when they returned - at a mean of 8 months post-treatment - were milder than prior to undergoing ILC+/-DA. CONCLUSION This is the first study to investigate intralesional corticosteroids +/- diathermy ablation for patients with AGG. Our results indicate this could be an effective treatment. We would recommend comparative and longitudinal studies to further explore this treatment.
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Affiliation(s)
- Kerri Cooper
- Department of Dermatology, St George's University Hospital, London, UK
| | - Joanna Bovis
- Department of Dermatology, St George's University Hospital, London, UK
| | - Kristiana Gordon
- Department of Dermatology, St George's University Hospital, London, UK
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6
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Zaladonis CA, Safeer LZ, Smith D, Hafeez F, Huang L, Errickson CV, Krakowski AC. Intralesional corticosteroid injections to treat lip swelling associated with oral Crohn's disease in a child. Pediatr Dermatol 2022; 39:506-508. [PMID: 35322470 DOI: 10.1111/pde.14968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This procedural report details the case of a 10-year-old boy with oral Crohn's disease successfully treated with intralesional corticosteroid injections. The intervention used topical anesthesia with a eutectic mixture of lidocaine 2.5%/prilocaine 2.5% cream followed by intralesional triamcinolone acetonide. This approach safely and effectively reduced patient discomfort while allowing for an acceptable and durable clinical outcome.
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Affiliation(s)
- Carly A Zaladonis
- Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA.,St. Luke's Department of Dermatology; St. Luke's University Health Network, Easton, Pennsylvania, USA
| | - Laraib Z Safeer
- St. Luke's Department of Dermatology; St. Luke's University Health Network, Easton, Pennsylvania, USA
| | - David Smith
- St. Luke's Department of Dermatology; St. Luke's University Health Network, Easton, Pennsylvania, USA
| | - Farhaan Hafeez
- St. Luke's Department of Dermatology; St. Luke's University Health Network, Easton, Pennsylvania, USA
| | - Laura Huang
- St. Luke's Department of Dermatology; St. Luke's University Health Network, Easton, Pennsylvania, USA
| | - Carla V Errickson
- St. Luke's Department of Dermatology; St. Luke's University Health Network, Easton, Pennsylvania, USA
| | - Andrew C Krakowski
- St. Luke's Department of Dermatology; St. Luke's University Health Network, Easton, Pennsylvania, USA
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7
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Pagani K, Lukac D, Bhukhan A, McGee JS. Cutaneous Manifestations of Inflammatory Bowel Disease: A Basic Overview. Am J Clin Dermatol 2022; 23:481-497. [PMID: 35441942 DOI: 10.1007/s40257-022-00689-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/30/2022]
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal (GI) tract that is subdivided into Crohn's disease (CD) and ulcerative colitis (UC). CD is characterized by involvement of the entire GI tract, while UC mainly affects the distal GI tract. Moreover, both CD and UC can present with extraintestinal manifestations (EIMs) of the disease affecting multiple organ systems including the hepatobiliary tract, kidney, bones, eyes, joints, and skin. These complications can cause significant morbidity and negatively impact the quality of life for IBD patients. Although the pathogenesis of EIMs is not clearly elucidated, it is postulated that the diseased GI mucosa similarly stimulates excess immune responses at the extraintestinal sites. Cutaneous EIMs occur in up to 15% of patients with IBD, often predating their IBD diagnosis. They are categorized into (1) specific, (2) reactive, (3) associated, and (4) treatment-induced. Here, we review the epidemiological, clinical, diagnostic, and histologic features of the most commonly described cutaneous EIMs of IBD along with their respective treatment options.
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Affiliation(s)
- Kyla Pagani
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Danitza Lukac
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Aashni Bhukhan
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Ft. Lauderdale, FL, USA
| | - Jean S McGee
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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8
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Wei M, Xie C, Liu Y, Wang Y, Wang Y, Wang X, Liu Y. Characterizing disease manifestations and treatment outcomes among patients with orofacial granulomatosis in China. JAAD Int 2021; 1:126-134. [PMID: 34409334 PMCID: PMC8362245 DOI: 10.1016/j.jdin.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2020] [Indexed: 02/06/2023] Open
Abstract
Background Racial variation exists in the incidence of orofacial granulomatosis (OFG). The epidemiology and clinical characteristics of OFG in Asian countries are poorly described. Objective To describe the epidemiologic and clinical features of OFG in China from data collected on chronic odontogenic infection and studied in actual practice regarding the long-term outcome of OFG patients receiving different treatments. Methods Data on demographics, medical history, chronic odontogenic infection, and the extent of disease were collected, and long-term outcomes after the end of treatments were evaluated. Results Of the 165 OFG patients, 118 (71.5%; 95% CI 64.6%-78.5%) had a chronic odontogenic infection. There was a variety of difference between OFG with and without chronic odontogenic infection. Approximately 98.3% (95% confidence interval 94.8%-100%) of OFG patients with chronic odontogenic infection who received dental treatment showed a marked response, of whom 31 patients (53.4%; 95% confidence interval 40.2%-66.7%) had complete remission. Limitations Endoscopic investigations were not performed for most of the patients, and more detailed data were not collected, which might have demonstrated additional systemic problems. Conclusions OFG with chronic odontogenic infection is the major clinical pattern of OFG in China, which may be a subtype of OFG. Dental treatment should necessarily be the preferred first-line therapy for such patients.
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Affiliation(s)
- Minghui Wei
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
| | - Cheng Xie
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
- Outpatient Department, School of Stomatology, the Fourth Military Medical University, Xi'an, China
| | - Yubo Liu
- Department of Stomatology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China
| | - Yuhong Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
| | - Yuanyuan Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
| | - Xinwen Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
- Correspondence to: Xinwen Wang, MD, PhD, or Yuan Liu, MD, PhD, Changle W Rd 145, Xi'an, 710032, Shaanxi Province, China.
| | - Yuan Liu
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
- Department of Pathology, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Correspondence to: Xinwen Wang, MD, PhD, or Yuan Liu, MD, PhD, Changle W Rd 145, Xi'an, 710032, Shaanxi Province, China.
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9
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Galdiero MR, Maio F, Arcoleo F, Boni E, Bonzano L, Brussino L, Cancian M, Cremonte L, Del Giacco SR, De Paulis A, Detoraki A, Firinu D, Lamacchia D, Loffredo S, Nettis E, Parente R, Parronchi P, Pellacani G, Petraroli A, Rolla G, Senter R, Triggiani M, Vitiello G, Spadaro G, Bova M. Orofacial granulomatosis: Clinical and therapeutic features in an Italian cohort and review of the literature. Allergy 2021; 76:2189-2200. [PMID: 33641182 DOI: 10.1111/all.14799] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/16/2021] [Accepted: 01/31/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is characterized by granulomatous inflammation of the soft tissues of maxillofacial region. We explored OFG patients from 10 different Italian centers and summarized the most recent literature data. METHODS A review of patients with OFG was carried out. An extensive online literature search was performed to identify studies reporting diagnosis and management of OFG. RESULTS Thirty-nine patients were recruited between January 2018 and February 2020. Most of them (97.4%) displayed involvement of the lips, and 28.2% suffered from Melkersson-Rosenthal syndrome. Two patients received diagnosis of CD and one patient of sarcoidosis, suggesting secondary OFG. Oral aphthosis and cervical lymphadenopathy were also described. The mean diagnostic delay was 3.4 years. Histological evaluation was performed in 34/39 patients (87.2%); non-caseating granulomas were found in 73.5% of them. Neurological symptoms (28.2%), gastrointestinal symptoms in absence of overt inflammatory bowel disease (IBD) (20.5%), and atopy (35.9%) were also identified. Therapeutic approaches varied among the centers. Steroids (51.3%) were used with good or partial results. Anti-TNF-α and anti-IgE monoclonal antibodies were used in 6 (15.4%) and 1 (2.6%) patients, respectively, with variable results. Surgery was the choice for 2 patients with good response. CONCLUSIONS OFG is a rare and neglected disease showing multiple clinical phenotypes. While early diagnosis is crucial, management is difficult and highly dependent on the expertise of clinicians due to the lack of international guidelines. There is a need to establish registry databases and address challenges of long-term management.
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Affiliation(s)
- Maria R. Galdiero
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Filomena Maio
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Francesco Arcoleo
- Ospedali Riuniti Villa Sofia‐CervelloUnità Operativa Complessa di Patologia Clinica Palermo Italy
| | - Elisa Boni
- Laboratorio Unico Metropolitano Maggiore Hospital AUSL Bologna Italy
| | - Laura Bonzano
- Dermatology and Allergy Unit Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology University of Turin & AO Mauriziano “UmbertoI” Turin Italy
| | - Mauro Cancian
- Department of Medicine University of Padova Padova Italy
| | - Luigi Cremonte
- Allergy Unit San Giacomo HospitalNovi Ligure Alessandria Italy
| | - Stefano R. Del Giacco
- Department of Medical Sciences and Public Health University of Cagliari Monserrato Italy
| | - Amato De Paulis
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Aikaterini Detoraki
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health University of Cagliari Monserrato Italy
| | | | - Stefania Loffredo
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation School of Allergology and Clinical Immunology University of Bari Aldo Moro Bari Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology University of Salerno Salerno Italy
| | - Paola Parronchi
- Experimental and Clinical Medicine Department University of Florence Florence Italy
| | - Giovanni Pellacani
- Dermatology and Allergy Unit Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Angelica Petraroli
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Giovanni Rolla
- Department of Medical Sciences, Allergy and Clinical Immunology University of Turin & AO Mauriziano “UmbertoI” Turin Italy
| | | | - Massimo Triggiani
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Gianfranco Vitiello
- Experimental and Clinical Medicine Department University of Florence Florence Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Maria Bova
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
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Pathological and Immunohistochemical Characteristics of Granuloma and Lymphatics in Cheilitis Granulomatosa. Am J Dermatopathol 2021; 44:83-91. [PMID: 33878045 DOI: 10.1097/dad.0000000000001952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Cheilitis granulomatosa (CG) is an idiopathic, rare, and chronic granulomatous disorder involving the lips. We characterized the pathological and immunohistopathological findings of these granulomas and their relationship with the lymphatic vessels. Pathologically confirmed cases of primary CG from 2001 to 2016 were collected. Cases of inflammatory cheilitis without the presence of granuloma were included in the control group. Demographic data, clinical presentation, response to therapy, and pathological differences were compared. Periodic acid-Schiff and acid-fast stains excluded patients having infections. CD68, CD163, and D2-40 stains demonstrated features of granuloma, macrophage polarization, and the relationship between granuloma and lymphatic vessels. Thirteen patients diagnosed with CG were enrolled. Thirteen people were enrolled in the control group. The granulomas were either mononuclear or sarcoidal. They were predominantly positive for CD68 but negative for CD163. Perilymphatic granulomas were found in all patients. Intralymphatic histiocytosis and lymphatic dilatation were more commonly observed in patients diagnosed with CG than those in controls (54% vs. 15%, P = 0.03 and 92% vs. 23%, P < 0.01). TH1 immune response due to CD68+ M1 macrophages results in CG. Perilymphatic aggregation of macrophages and intralymphatic histiocytosis were important pathological clues for diagnosis.
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Joseph M, Chew WT, Seeborg F, Satter LF, Anvari S, Chinn IK, Davis CM, Gupta MR, Nicholas S, Noroski LM, James M, Deniskin R, Diaz VC, Lowe J, Lee GL, Craddock MF, Chan AJ, Rider NL. Intralesional Corticosteroids as Adjunctive Therapy for Refractory Cutaneous Lesions in Chronic Granulomatous Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:2769-2770. [PMID: 32600996 DOI: 10.1016/j.jaip.2020.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Michelle Joseph
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, Texas.
| | - Wai-Tim Chew
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, Texas
| | - Filiz Seeborg
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, Texas
| | - Lisa Forbes Satter
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, Texas
| | - Sara Anvari
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, Texas
| | - Ivan K Chinn
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, Texas
| | - Carla M Davis
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, Texas
| | - Meera R Gupta
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, Texas
| | - Sarah Nicholas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, Texas
| | - Lenora M Noroski
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, Texas
| | - Mansi James
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, Texas
| | - Roman Deniskin
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, Texas
| | - Veronica C Diaz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, Texas
| | - Juliette Lowe
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Wound Ostomy and Continence Department, Texas Children's Hospital, Houston, Texas
| | - Grace L Lee
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Pediatric Dermatology, Texas Children's Hospital, Houston, Texas
| | - Megan F Craddock
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Pediatric Dermatology, Texas Children's Hospital, Houston, Texas
| | - Audrey J Chan
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Pediatric Dermatology, Texas Children's Hospital, Houston, Texas
| | - Nicholas L Rider
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Rheumatology, Texas Children's Hospital, Houston, Texas
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12
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Dhawan SR, Saini AG, Singhi PD. Management Strategies of Melkersson-Rosenthal Syndrome: A Review. Int J Gen Med 2020; 13:61-65. [PMID: 32161488 PMCID: PMC7049838 DOI: 10.2147/ijgm.s186315] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/22/2020] [Indexed: 12/23/2022] Open
Abstract
Melkerrson-Rosenthal syndrome is a rare disorder of unknown aetiology and characterized by the triad of oro-facial edema, facial nerve palsy, and furrowing of the tongue. Two or more of the above are essential for making a clinical diagnosis. The mainstay of treatment is corticosteroids. Intralesional triamcinolone acetonide may be used for the treatment of oro-facial edema. Another treatment option for oro-facial edema includes intralesional betamethasone, along with oral doxycycline. The review discusses the management strategies in Melkersson-Rosenthal syndrome.
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Affiliation(s)
- Sumeet R Dhawan
- Department of Pediatrics, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, 133207, India
| | - Arushi G Saini
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Pratibha D Singhi
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.,Medanta, The Medicity, Gurgaon, Haryana, India
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13
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Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, Hayee B, Lomer MCE, Parkes GC, Selinger C, Barrett KJ, Davies RJ, Bennett C, Gittens S, Dunlop MG, Faiz O, Fraser A, Garrick V, Johnston PD, Parkes M, Sanderson J, Terry H, Gaya DR, Iqbal TH, Taylor SA, Smith M, Brookes M, Hansen R, Hawthorne AB. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019; 68:s1-s106. [PMID: 31562236 PMCID: PMC6872448 DOI: 10.1136/gutjnl-2019-318484] [Citation(s) in RCA: 1221] [Impact Index Per Article: 244.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Abstract
Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn's disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn's disease, including patients, their families and friends.
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Affiliation(s)
- Christopher Andrew Lamb
- Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicholas A Kennedy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- University of Exeter, Exeter, UK
| | - Tim Raine
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Philip Anthony Hendy
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - Philip J Smith
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Jimmy K Limdi
- The Pennine Acute Hospitals NHS Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Bu'Hussain Hayee
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Miranda C E Lomer
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gareth C Parkes
- Barts Health NHS Trust, London, UK
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Christian Selinger
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | | | - R Justin Davies
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Cathy Bennett
- Systematic Research Ltd, Quorn, UK
- Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | | | - Malcolm G Dunlop
- University of Edinburgh, Edinburgh, UK
- Western General Hospital, Edinburgh, UK
| | - Omar Faiz
- Imperial College London, London, UK
- St Mark's Hospital, Harrow, UK
| | - Aileen Fraser
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | - Miles Parkes
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Jeremy Sanderson
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Daniel R Gaya
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, Glasgow, UK
| | - Tariq H Iqbal
- Queen Elizabeth Hospital Birmingham NHSFoundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Stuart A Taylor
- University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Melissa Smith
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Matthew Brookes
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
- University of Wolverhampton, Wolverhampton, UK
| | - Richard Hansen
- Royal Hospital for Children Glasgow, Glasgow, UK
- University of Glasgow, Glasgow, UK
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14
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Abstract
Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn's disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn's disease, including patients, their families and friends.
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15
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Fantozzi PJ, Treister N, Shekar R, Woo SB, Villa A. Intralesional triamcinolone acetonide therapy for inflammatory oral ulcers. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:485-490. [PMID: 31466871 DOI: 10.1016/j.oooo.2019.07.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/17/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to report on the clinical indications and treatment outcomes of intralesional steroid therapy (IST) for oral ulcerative conditions in an oral medicine practice. STUDY DESIGN This was a retrospective single-center study of patients with oral ulcerative conditions treated with IST. Demographic data, clinical diagnosis of the oral condition, size of the ulcer, and pain were abstracted from patients' electronic medical records. RESULTS Ninety-three patients (51 females [54.8%]) were treated for persistent traumatic oral ulcers (n = 38 [40.8%]), ulcers in oral chronic graft-versus-host disease (n = 23 [24.7%]), oral lichen planus (n = 19 [20.4%]), and other conditions (14%). Complete resolution was achieved in 81.7% of patients in a median of 96 days (range 10-357 days), with 80% fully healed in a median of 84 days (range 10-140 days). Overall, patients received a median of 2 injections (range 1-5 injections) and a median dose of 12 mg per injection (range 2-36 mg). Nearly half the patients were also treated with concomitant topical steroid therapy. After the first injection, the median pain score reduced from 5 (range 1-10) to 1 (range 0-10; P < .001) and the median size of ulcers reduced from 1 cm (range 0.1-5 cm) to 0.3 cm (range 0-2 cm; P < .001). CONCLUSIONS IST may be an effective treatment for inflammatory and immune-mediated oral ulcers.
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Affiliation(s)
- Paolo J Fantozzi
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Revathi Shekar
- Consultant Oral Pathologist, and Oral Medicine Specialist, Bangalore, Karnataka, India
| | - Sook-Bin Woo
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Alessandro Villa
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
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16
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Fok JS, Katelaris CH. Angioedema Masqueraders. Clin Exp Allergy 2019; 49:1274-1282. [PMID: 31310036 DOI: 10.1111/cea.13463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/27/2019] [Accepted: 07/05/2019] [Indexed: 12/24/2022]
Abstract
Angioedema is a common reason for referral to immunology and allergy specialists. Not all cases are in fact angioedema. There are many conditions that may mimic its appearance, resulting in misdiagnosis. This may happen when a clinician is unfamiliar with conditions resembling angioedema or when there is a low index of clinical suspicion. In this article, we explore a list of differential diagnoses based on body parts, including the lips, the limbs, periorbital tissues, the face, epiglottis and uvula, as well as the genitalia, that may pose as a masquerader even to an experienced eye.
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Affiliation(s)
- Jie Shen Fok
- Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Constance H Katelaris
- Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, New South Wales, Australia.,School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
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17
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Jácome-Santos H, Resende RG, Silva AMB, Cruz AF, Tanos de Lacerda SH, Mesquita RA, Tanos de Lacerda JC. Low-level laser as a complementary therapy in orofacial granulomatosis management: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:e1-e5. [DOI: 10.1016/j.oooo.2019.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/03/2019] [Accepted: 02/23/2019] [Indexed: 12/20/2022]
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18
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Hullah EA, Escudier MP. The mouth in inflammatory bowel disease and aspects of orofacial granulomatosis. Periodontol 2000 2019; 80:61-76. [DOI: 10.1111/prd.12264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Esther A. Hullah
- Faculty of DentistryOral & Craniofacial SciencesKing's College London UK
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19
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Bavarian R, Sultan AS, Villa A. A persistent swelling of the lower lip. J Am Dent Assoc 2019; 150:378-382. [DOI: 10.1016/j.adaj.2018.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 06/19/2018] [Accepted: 07/21/2018] [Indexed: 10/28/2022]
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20
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Pandya H, Patel HD, Purani JM, Rayththa VIR. Idiopathic macrocheilia. BMJ Case Rep 2018; 2018:bcr-2018-225682. [PMID: 30262529 DOI: 10.1136/bcr-2018-225682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 13-year-boy presented with painless swelling of upper and lower lips accompanied with gingival enlargement. The aetiology for these symptoms included vast pathological varieties but none of them could fit in. Clinical features were similar to orofacial graulomatosis but histopathological examination revealed chronic non-specific infection. Therefore, the final diagnosis was made as idiopathic macrocheilia through exclusion criteria. Management with intralesional triamcinolone acetonide 40 mg, twice a week for 3 weeks, resulted in significant remission in lip swelling without recurrence after a 6-month follow-up.
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Affiliation(s)
- Haren Pandya
- Oral and Maxillofacial Surgery, Dharmsinh Desai University Faculty of Dental Science, Nadiad, Gujarat, India
| | | | | | - VIvek Ramesh Rayththa
- Oral and Maxillofacial Surgery, Dharmsinh Desai University Faculty of Dental Science, Nadiad, Gujarat, India
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21
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STAT3-Deficient hyperimmunoglobulin E syndrome: report of a case with orofacial granulomatosis-like disease. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:e252-e257. [PMID: 30126807 DOI: 10.1016/j.oooo.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 07/05/2018] [Accepted: 07/10/2018] [Indexed: 12/31/2022]
Abstract
Hyperimmunoglobulin E syndrome (HIES) is a rare heterogeneous primary immunodeficiency disorder characterized by infections of the lung and skin, elevated serum immunoglobulin E, and involvement of soft and bony tissues. Autosomal dominant HIES and related disorders are caused by defects in the Janus activated kinase-signal transducer and activator of transcription signaling pathway, leading to reduced numbers of T helper cell type 17 and impaired production of interleukin (IL)-17 A, IL-17 F, and IL-22. In addition, neutrophils have chemotactic defects, resulting in impaired responses at skin and lung sites. We report here a case of orofacial granulomatosis-like disease in a teenage boy ultimately found to have autosomal dominant HIES caused by a heterozygous mutation in the STAT3 gene.
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22
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Espinoza I, Navarrete J, Benedetto J, Borzutzky A, Roessler P, Ortega-Pinto A. Orofacial granulomatosis and diet therapy: a review of the literature and two clinical cases. An Bras Dermatol 2018; 93:80-85. [PMID: 29641703 PMCID: PMC5871368 DOI: 10.1590/abd1806-4841.20185828] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/09/2016] [Indexed: 03/04/2023] Open
Abstract
Orofacial granulomatosis is a nonspecific term that contains a wide variety of
granulomatous entities, which share a clinical and histopathological
presentation. It manifests as persistent or recurrent orofacial swelling,
amongst other findings. Idiopathic orofacial granulomatosis, characterized by an
absence of systemic granulomatous disease, is a diagnosis of exclusion. The main
differential diagnosis is Crohn's disease. Its pathogenesis is unknown, however,
it seems to be immune-mediated. Patch-test sensitivity to multiple allergens is
well documented. Currently, therapeutic options consider restrictive diets,
topical, intralesional, and systemic agents. First-line therapy is currently a
matter of debate. We present a review of the value of diet therapy in this
syndrome, along with two illustrative cases.
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Affiliation(s)
- Iris Espinoza
- Oral Biopsy Service at Dental School, University of Chile - Santiago, Chile
| | - Jorge Navarrete
- Dermatology Service, Clinics Hospital Dr. Manuel Quintela - University of the Republic - Montevideo, Uruguay
| | - Juana Benedetto
- Dermatology Service, Alemana de Santiago Clinic - Santiago, Chile.,Dermatology Department, University del Desarrollo - Región del Bío Bío, Chile
| | - Arturo Borzutzky
- Immunology, Allergy and Pediatric Rheumatology, Pontifical Catholic University of Chile - Santiago, Chile
| | | | - Ana Ortega-Pinto
- Department of Oral Pathology and Medicine, University of Chile - Santiago, Chile
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23
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Feugueur G, Konstantinou MP, Croze J, Laurencin S, Cousty S. Management of orofacial granulomatosis: a case report. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2017021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Orofacial granulomatosis is characterized by recurrent swelling affecting the lips, cheeks, and tongue. The rarity of this pathology and the lack of consensus in therapeutic management make the reporting of this clinical case relevant. Observation: A 48-year-old man consulted for labial and gingival orofacial granulomatosis. The treatment consisted of 40 mg/L injections of triamcinolone acetonide once weekly for 3 weeks. The symptoms improved after 1 week of treatment. Comments: The usual treatment for this condition targets the inflammation caused by the lesion. Corticosteroids (clobetasol, triamcinolone acetonide, prednisolone), monoclonal antibodies (infliximab, adalimumab), or TNF-α inhibitors are commonly used. Symptom recurrenceis frequently observed after treatment with corticosteroids. Biotherapies are often used as a second-line treatment. Conclusion: Orofacial granulomatosis symptoms are rare and difficult to diagnose due to its varying manifestations. Common treatments target one of the steps of the inflammatory response. The detection of specific cellular markers is a way to enable a more precise etiological diagnosis and allows for a more targeted therapy.
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25
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Abstract
Orofacial granulomatosis (OFG) is a condition manifesting clinically with chronic swelling of the mouth and/or face, notably with swelling of the lips and oral mucosa, a full-thickness, erythematous gingivitis and mucosal ulceration of various clinical types. Some patients may also present with neurological findings, for example facial palsy. Biopsy of affected tissue shows lymphoedema, with or without granulomatous inflammation. The oral lesions in OFG are histologically indistinguishable from the oral lesions in Crohn's disease (CD) and other systemic granulomatous disorders. It is a condition which may respond to the exclusion of certain food-related chemicals from the diet in up to 60% of patients and, as such, is distinct from gastrointestinal CD. CD is a relapsing systemic inflammatory disease which predominantly affects the gut, and patients suffering from this disease frequently present with abdominal pain, fever and altered bowel habit. A proportion of patients with clinical OFG (without other systemic disease) may have asymptomatic gastrointestinal involvement or go on to develop gut CD suggesting an association between the two diseases. It is estimated that 1% of CD sufferers may have a diagnosis of OFG, but the majority of patients in specialist OFG clinics do not have gut symptoms.
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Affiliation(s)
- Esther A Hullah
- Guy's and St Thomas' NHS Foundation Trust, Department of Oral Medicine, London, UK
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26
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Abstract
Orofacial granulomatosis (OFG) is an uncommon chronic inflammatory disorder of the orofacial region. It is characterized by subepithelial noncaseating granulomas and has a spectrum of possible clinical manifestations ranging from subtle oral mucosal swelling to permanent disfiguring fibrous swelling of the lips and face. Etiopathogenesis is unknown. A range of systemic granulomatous disorders, including Crohn disease and sarcoidosis, may cause orofacial manifestations that cannot be distinguished from those of OFG. Treatment of OFG has proven difficult and unsatisfactory, with no single therapeutic model showing consistent efficacy in reducing orofacial swelling and mucosal inflammation.
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Affiliation(s)
- Arwa Al-Hamad
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK; Dental Services, Ministry of National Guard, King Abdulaziz Medical City-Riyadh, Riyadh, Saudi Arabia
| | - Stephen Porter
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK
| | - Stefano Fedele
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK; NIHR University College London Hospitals Biomedical Research Centre, Maple House, Suite A, 1st floor, 149 Tottenham Court Road, London W1T 7DN, UK; Oral Medicine Unit, Eastman Dental Hospital, University College London Hospitals Trust, 256 Gray's Inn Road, London WC1X 8LD, UK.
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