Ultrastructural findings and clinical follow-up of 'strawberry gums' in Wegener's granulomatosis

Oral granulomatosis with polyangiitis a systematic review

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.

Lingual infarction in Wegener's Granulomatosis: a case report and review of the literature

Wegener's granulomatosis (WG) is a multi-system disease, characterised by the triad of necrotising granulomata affecting the upper and lower respiratory tracts, disseminated vasculitis and glomerulonephritis. Oral lesions are associated with up to 50% of cases, although are rare as a presenting feature. The most common oral lesions associated with WG are ulceration and strawberry gingivitis. We review the literature regarding oral manifestations of WG and present a case of lingual infarction, an extremely rare oral lesion associated with WG, in a severe, rapidly progressive and ultimately fatal form of the disease.

Diagnosis and management of Wegener's granulomatosis in a dog

A four-year-old maele/neutered mixed-breed dog was prsented for severe, multifocal, proliferative gingivitis. Histopathologic examination of incisional biopsies supported a diagnosis of Wegener's granulomatosis, an autoimmune vasculitis previously unreported in the veterinary literature. Diagnostic investigations for infectious, neoplastic, or other inflammatory conditions all provided negative results. Management with a combination of immunosuppressive agents resulted in complete resolution and remission of the presenting lesions and associated clinical signs.

Oral lesions as the first clinical sign of microscopic polyangiitis: a case report

Microscopic polyangiitis (MPA) is defined as a systemic necrotizing vasculitis that clinically and histologically affects small-sized vessels without granulomata. The main clinical feature of MPA is renal involvement characterized by rapidly progressing glomerulonephritis. We report a case of oral lesions, initially thought to be associated with Wegener's granulomatosis, as the first sign of MPA in an otherwise healthy man. To our knowledge, this is the first published case of MPA-associated oral lesions.

Wegener's granulomatosis presenting as oral lesions: a case report

Wegener's granulomatosis will classically present as a triad of respiratory, kidney, and vascular involvement. The disease may run a course of rapidly progressive or mild and indolent and escape diagnosis for some time. The clinician must be aware of the possibility of Wegener's granulomatosis presenting initially with intraoral lesions. Prompt biopsies and blood studies along with the proper referrals will give the patient their best chance at a remission with the least systemic damage. We present a case of Wegener's granulomatosis that presented with oral lesions before other signs and symptoms.

Strawberry gums: a clinicopathological manifestation diagnostic of Wegener's granulomatosis?

AIMS

To highlight an uncommon but characteristic gingival lesion associated with Wegener's granulomatosis, emphasising the presence of pseudoepitheliomatous hyperplasia, microabscesses, and multinucleate giant cells; and the paucity of the currently accepted histopathological criteria of Wegener's granulomatosis--namely necrosis, vasculitis, and granulomata.

METHODS

The histopathological features of a gingival biopsy specimen from a case of Wegener's granulomatosis limited to the upper aerodigestive tract in a 36 year old woman were compared with those of 14 similar reported cases.

RESULTS

Pseudoepitheliomatous hyperplasia, microabscesses, and multinucleate giant cells were recorded as present in almost all cases of gingival Wegener's granulomatosis. Necrosis, vasculitis, and granuloma formation were present in only a few cases.

CONCLUSIONS

The combination of pseudoepitheliomatous hyperplasia, microabscesses, and multinucleate giant cells in a gingival biopsy specimen from erythematous, swollen gums, clinically resembling over-ripe strawberries, in a patient with a severe systemic upset, is so typical of Wegener's granulomatosis as to be virtually diagnostic. Recognition of this characteristic lesion may aid early diagnosis and treatment in cases where other diagnostic variables are absent.

Oral manifestations of Wegener's granulomatosis. Review of the literature and report of a case

Wegener's granulomatosis (WG) is a rare granulomatous vasculitis which used to run a fatal course. At present, it is possible to control or sometimes even cure the disease with immunosuppressives. Successful treatment depends largely on early diagnosis. Based on a review of the literature, the diagnostic relevance of hyperplastic gingivitis (HG) is discussed. HG should be considered an early sign of WG in contrast to oral ulcers.

Oral presentation of Wegener granulomatosis

Although the mouth is often involved in Wegener granulomatosis, oral lesions as the initial sign are rare. This case report documents the importance of considering Wegener granulomatosis in patients with unique oral lesions. The most common lesion is a friable-granular-hyperplastic gingivitis associated with alveolar resorption and tooth mobility. The disease may remain localized to the mouth for several weeks or months before multiorgan involvement occurs. Gingival enlargement is a direct manifestation of Wegener granulomatosis, and it may be pathognomonic. Failure to recognize the clinical lesions can result in delayed diagnosis and treatment, with potentially fatal results.