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Panigrahi R, Priyadarshini SR, Sahoo PK, Alam T, Saeed S, Hasan S. Lepromatous Leprosy Manifesting As Chronic Macrocheilia: Report of a Rare Case. Cureus 2023; 15:e47859. [PMID: 38021977 PMCID: PMC10680308 DOI: 10.7759/cureus.47859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Leprosy is a chronic debilitating disorder caused by the acid-fast bacilli Mycobacterium leprae (M. leprae) and Mycobacterium lepromatosis. These bacilli exhibit a distinctive predilection for the skin and peripheral nerves, although they can potentially impact any system in the body. Lately, there has been a notable reduction in mucosal symptoms, largely attributed to the timely diagnosis and treatment of leprosy. Nonetheless, oral lesions continue to hold significant epidemiological importance due to their crucial role in disease transmission. Oral manifestations, although rare, are frequently encountered in individuals afflicted with multi-bacillary leprosy. Chronic macrocheilia is an exceedingly rare manifestation of the disease, with only a few documented case reports and case studies. This article aims to document an exceptionally uncommon case of lepromatous leprosy with chronic macrocheilia as the sole presenting feature.
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Affiliation(s)
- Rajat Panigrahi
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, Siksha O Anusandhan University, Bhubaneswar, IND
| | - Smita R Priyadarshini
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, Siksha O Anusandhan University, Bhubaneswar, IND
| | - Pradyumna K Sahoo
- Department of Prosthodontics, Institute of Dental Sciences, Siksha O Anusandhan University, Bhubaneswar, IND
| | - Tanveer Alam
- Department of Dental Surgery, College of Dentistry King Khalid University, Abha, SAU
| | - Shazina Saeed
- Department of Epidemiology and Public Health, Amity Institute of Public Health & Hospital Administration, Amity University, Noida, IND
| | - Shamimul Hasan
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, IND
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Nylund K, Helenius‐Hietala J, Åberg F, Hagström J, Ruokonen H. Persistent oral mucosal lesions preceding diagnosis of Crohn's disease and primary sclerosing cholangitis. Clin Case Rep 2023; 11:e07226. [PMID: 37180315 PMCID: PMC10172456 DOI: 10.1002/ccr3.7226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/19/2023] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
Oral mucosal lesions may persist years before symptoms or diagnosis of inflammatory bowel disease (IBD) and subsequent primary sclerosing cholangitis (PSC). Since a dental practitioner may be the first clinician to suspect IBD with extraintestinal manifestations (EIMs), early referral, and close collaboration with a gastroenterologist are recommended.
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Affiliation(s)
- Karita Nylund
- Department of Oral and Maxillofacial DiseasesHUS Helsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Jaana Helenius‐Hietala
- Department of Oral and Maxillofacial DiseasesHUS Helsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Fredrik Åberg
- Department of Transplantation and Liver SurgeryHUS Helsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Jaana Hagström
- Department of Oral Pathology and Radiology, Faculty of MedicineUniversity of TurkuTurkuFinland
- Department of PathologyHUS Helsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Hellevi Ruokonen
- Department of Oral and Maxillofacial DiseasesHUS Helsinki University Hospital and University of HelsinkiHelsinkiFinland
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Elmaghrawy K, Hussey S, Moran GP. The Oral Microbiome in Pediatric IBD: A Source of Pathobionts or Biomarkers? Front Pediatr 2021; 8:620254. [PMID: 33553076 PMCID: PMC7859511 DOI: 10.3389/fped.2020.620254] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/14/2020] [Indexed: 12/22/2022] Open
Abstract
The oral cavity is continuous with the gastrointestinal tract and in children, oral health may be closely linked with the overall health of the GI tract. In the case of pediatric Crohn's disease (CD), oral manifestations are an important clinical indicator of intestinal disease. Recent studies of the microbiome in IBD suggest that translocation of oral microbes to the gut may be a common feature of the microbial dysbiosis which is a signature of both CD and ulcerative colitis (UC). Murine studies suggest that translocation of oral bacteria and yeasts to the lower GI tract may trigger inflammation in susceptible hosts, providing a mechanistic link to the development of IBD. Conversely, some studies have shown that dysbiosis of the oral microbiome may occur, possibly as a result of inflammatory responses and could represent a useful source of biomarkers of GI health. This review summarizes our current knowledge of the oral microbiome in IBD and presents current hypotheses on the potential role of this community in the pathogenesis of these diseases.
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Affiliation(s)
- Khalid Elmaghrawy
- School of Dental Science, Trinity College Dublin and Dublin Dental University Hospital, Dublin, Ireland
| | - Séamus Hussey
- Department of Paediatrics, University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- National Children's Research Centre, Dublin, Ireland
| | - Gary P. Moran
- School of Dental Science, Trinity College Dublin and Dublin Dental University Hospital, Dublin, Ireland
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Huang ML, Wu YQ, Ruan WH. A rare case of pediatric Crohn's disease and alveolar bone loss: a report and review. Transl Pediatr 2020; 9:720-725. [PMID: 33209737 PMCID: PMC7658762 DOI: 10.21037/tp-20-279] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Crohn's disease (CD) is a granulomatous inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract, but its etiology is still unclear. CD patients usually have extraintestinal manifestations including oral manifestations, and this can also occasionally appear in children. Oral manifestations, including aphthous stomatitis, typically develop on the mucocutaneous tissue. As pediatric CD is not common, there have been no reports concerning alveolar bone resorption for these kinds of patients. An 11-year-old Chinese girl was referred to our hospital because of reoccurring painful oral ulcers, with a 2.5-year history of CD and recurrent oral ulcers. Clinical examinations revealed intestinal lesions, oral ulcers, and alveolar bone loss. CD and its related periodontitis were diagnosed. After comprehensive therapy, including periodontal scaling and anti-inflammatory treatment, the oral ulcers gradually healed. One year later, follow-up visit showed the anterior alveolar bone to be stable and new alveolar bone regenerating around the mandibular anterior teeth at some sites. It is rare for CD children to have periodontitis, especially with severe alveolar bone loss. This case suggests that when treating periodontitis in children, the possibility of systemic disease, such as CD, should be considered and attended to. Early diagnosis and symptomatic treatment and care are crucial.
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Affiliation(s)
- Mei-Li Huang
- Department of Otolaryngology Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying-Qian Wu
- Department of Stomatology, the Children's Hospital, Zhejiang University School of Medicine, National Clinic Research Center for Child Health, Hangzhou, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, China
| | - Wen-Hua Ruan
- Department of Stomatology, the Children's Hospital, Zhejiang University School of Medicine, National Clinic Research Center for Child Health, Hangzhou, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, China
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Kurtovic A, Bass JA, Horii KA. Painless lip swelling in a child. Pediatr Dermatol 2020; 37:e69-e70. [PMID: 32981164 DOI: 10.1111/pde.14247] [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: 03/29/2020] [Revised: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Adnan Kurtovic
- University of Kansas Medical Center Dermatology, Kansas City, KS, USA
| | - Julie A Bass
- Children's Mercy Gastroenterology, Kansas City, MO, USA
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Diaconescu S, Strat S, Balan GG, Anton C, Stefanescu G, Ioniuc I, Stanescu AMA. Dermatological Manifestations in Pediatric Inflammatory Bowel Disease. Medicina (B Aires) 2020; 56:medicina56090425. [PMID: 32842528 PMCID: PMC7559248 DOI: 10.3390/medicina56090425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/09/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022] Open
Abstract
Background and Objectives: Over the last years, inflammatory bowel disease (IBD) has been reported on a high incidence in pediatric populations and has been associated with numerous extraintestinal manifestations, making its management a real challenge for the pediatric gastroenterologist. Dermatological manifestations in IBD are either specific, related to the disease activity or treatment-associated, or non-specific. This literature review aims to identify and report the dermatological manifestations of IBD in children, the correlation between their appearance and the demographical characteristics, the relationship between these lesions and disease activity, and to highlight the impact of dermatological manifestations on an IBD treatment regime. Materials and Methods: A systemic literature review was performed, investigating articles and case reports on dermatological manifestations in children with IBD starting from 2005. A total of 159 potentially suitable articles were identified and after the exclusion process, 75 articles were selected. Results: The most common dermatological manifestations reported in pediatric IBD are erythema nodosum and pyoderma gangrenosum. More rare cases of metastatic Crohn’s disease, epidermolysis bullosa acquisita, small-vessel vasculitis, necrotizing vasculitis, leukocytoclastic vasculitis, cutaneous polyarteritis nodosa, and Sweet’s syndrome have been reported. Oral manifestations of IBD are divided into specific (tag-like lesions, mucogingivitis, lip swelling with vertical fissures, aphthous stomatitis, and pyostomatitis vegetans) and non-specific. IBD treatment may present with side effects involving the skin and mucosa. Anti-tumor necrosis factor agents have been linked to opportunistic skin infections, psoriasiform lesions, and a potentially increased risk for skin cancer. Cutaneous manifestations such as acrodermatitis enteropathica, purpuric lesions, and angular cheilitis may appear secondary to malnutrition and/or malabsorption. Conclusions: The correct diagnosis of dermatological manifestations in pediatric IBD is of paramount importance because of their impact on disease activity, treatment options, and a patient’s psychological status.
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Affiliation(s)
- Smaranda Diaconescu
- Department of Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.D.); (I.I.)
- Clinical Department of Pediatric Gastroenterology, “St. Mary” Emergency Children’s Hospital, 700309 Iasi, Romania
| | - Silvia Strat
- Clinical Department of Pediatric Gastroenterology, “St. Mary” Emergency Children’s Hospital, 700309 Iasi, Romania
- Correspondence: ; Tel.: +40-768-035-458
| | - Gheorghe G. Balan
- Gastroenterology and Hepatology Clinic, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (G.G.B.); (C.A.); (G.S.)
- Department of Gastroenterology and Hepatology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Carmen Anton
- Gastroenterology and Hepatology Clinic, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (G.G.B.); (C.A.); (G.S.)
- Department of Gastroenterology and Hepatology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Gabriela Stefanescu
- Gastroenterology and Hepatology Clinic, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (G.G.B.); (C.A.); (G.S.)
- Department of Gastroenterology and Hepatology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ileana Ioniuc
- Department of Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.D.); (I.I.)
- Department of Pediatrics, “St. Mary” Emergency Children’s Hospital, 700309 Iasi, Romania
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Müller S. Non-infectious Granulomatous Lesions of the Orofacial Region. Head Neck Pathol 2019; 13:449-456. [PMID: 30627963 PMCID: PMC6684712 DOI: 10.1007/s12105-018-00997-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/20/2018] [Indexed: 02/06/2023]
Abstract
Granulomatous lesions of the orofacial region are a heterogeneous group of disorders characterized by a granulomatous reaction to a variety of stimuli. Infectious agents, foreign material, systemic inflammation and metabolic disorders can all be associated with granulomatous inflammation. In the orofacial region primary causes of granulomatosis include foreign body reaction, delayed hypersensitivity to topical agents and idiopathic orofacial granulomatosis. Secondary causes of granulomas include infectious agents, sarcoid, and Crohn disease. For this review, infectious causes of orofacial granulomatosis (OFG) including bacteria, parasites and fungi will not be discussed.
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Affiliation(s)
- Susan Müller
- Atlanta Oral Pathology, Emory Decatur Hospital, Emory University School of Medicine, 2701 N. Decatur Road, Decatur, GA, 30033, USA.
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Eckel A, Lee D, Deutsch G, Maxin A, Oda D. Oral manifestations as the first presenting sign of Crohn's disease in a pediatric patient. J Clin Exp Dent 2017; 9:e934-e938. [PMID: 28828164 PMCID: PMC5549595 DOI: 10.4317/jced.53914] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/20/2017] [Indexed: 12/24/2022] Open
Abstract
Crohn’s disease (CD) is a chronic inflammatory disorder affecting the gastrointestinal (GI) tract. Although the GI tract is the primary site of involvement, many patients, particularly in pediatric cases, first present with non-intestinal manifestations, including oral lesions. Oral manifestations of CD in children occur in around 50-80% of cases, and about 30% of CD cases in children occur first in the mouth. Recognizing such oral lesions in the pediatric population, and requesting a biopsy, may expedite the diagnosis of CD. We describe a 15 year old male who presented with oral findings of multiple aphthous ulcers and plaques of pink papules of the buccal vestibule. We highlight the initial pathology findings, including non-caseating granulomas, sialadenitis, and a notable plasmacytosis, from biopsy of the left retromolar pad area, which triggered further testing for CD. We provide discussion of how CD was eventually diagnosed and treated and highlight the significance of the pathological findings in this case as they relate to the pathogenesis of CD.
Key words:Crohn’s disease, Inflammatory bowel disease, Oral manifestations, Pediatric, Granulomatous inflammation, Monotypic plasma cells.
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Affiliation(s)
- Ashley Eckel
- MD, PhD, University of Washington, Department of Laboratory Medicine, Seattle, WA
| | - Dale Lee
- MD, MSCE, Seattle Children's Hospital, Division of Gastroenterology and Hepatology, Seattle, WA
| | - Gail Deutsch
- MD, Seattle Children's Hospital, Department of Pathology, Seattle, WA
| | | | - Dolphine Oda
- BDS, MSc, University of Washington School of Dentistry, Department of Oral & Maxillofacial Surgery, Seattle, WA
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Bai YD, Sankarapandian S, Aditi R. A Wide Spread Red Lesion on the Surface of the Tongue-A Case Report and Review of Differential Diagnosis. J Clin Diagn Res 2017; 11:ZD07-ZD09. [PMID: 28764305 DOI: 10.7860/jcdr/2017/27813.10005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 05/01/2017] [Indexed: 11/24/2022]
Abstract
The tongue is considered to be the strongest muscular organ in the body and a very important structure in the oral cavity. It is involved in various critical functions such as taste, speech, chewing and deglutition. It has been known to be a harbinger of systemic health and disease. Lesions occurring on the tongue vary widely in colour and consistency. Widespread red lesions on the tongue need to be differentiated carefully from each other for a proper diagnosis and treatment and must be followed up for recurrence. The present case report demonstrates a widespread longstanding recurrent red lesion occurring on the surface of the tongue, its diagnosis and management.
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Affiliation(s)
- Yenduluri Durga Bai
- Associate Professor, Department of Periodontics, Government Dental College and Hospital, Hyderabad, Telangana, India
| | | | - R Aditi
- Assistant Professor, Department of Oral Medicine and Radiology, Sri Sai College of Dental Surgery, Hyderabad, Telangana, India
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