J Periodontal Implant Sci.  2015 Dec;45(6):247-251. 10.5051/jpis.2015.45.6.247.

Role of gingival manifestation in diagnosis of granulomatosis with polyangiitis (Wegener's granulomatosis)

• Sung IY
• Kim YM
• Cho YC
• Son JH

• KMID: 2354943
• DOI: http://doi.org/10.5051/jpis.2015.45.6.247

Abstract

PURPOSE
This report describes a case of granulomatosis with polyangiitis (GPA) in which the gingival manifestation was crucial in both making an early diagnosis and possibly in deciding the approach to treatment.
METHODS
A 57-year-old sailor presented to the Department of Dentistry at Ulsan University Hospital complaining of gingival swelling since approximately 2 months. He had orofacial granulomatous lesions and the specific gingival manifestation of strawberry gingivitis.
RESULTS
The diagnosis of GPA was made on the basis of clinical symptoms and signs, and confirmed by the presence of the anti-neutrophil cytoplasmic antibody and a positive biopsy. The patient was admitted to the hospital and subsequently placed on a disease-modifying therapy regimen that included methotrexate and prednisone.
CONCLUSIONS
Identification of the gingival manifestation of the disease permitted an early diagnosis and prompt therapy in a disease in which time is a crucial factor. Because of its rapid progression and potentially fatal outcome, an early diagnosis of GPA is important. Therefore, dentists should be aware of the oral signs and symptoms of such systemic diseases.

Keyword

Diagnosis; Gingiva; Granulomatosis with polyangiitis; Orofacial

MeSH Terms

Antibodies, Antineutrophil Cytoplasmic
Biopsy
Dentistry
Dentists
Diagnosis*
Early Diagnosis
Fatal Outcome
Fragaria
Gingiva
Gingivitis
Humans
Methotrexate
Middle Aged
Military Personnel
Prednisone
Ulsan
Antibodies, Antineutrophil Cytoplasmic
Methotrexate
Prednisone

Figure

• 

  Figure 1 An image showing the granulomatous ulcerations on the patients’ face and the “strawberry-like”appearance of the upper/lower gingivae.

• 

  Figure 2 An image showing the exposure of the underlying alveolar bone (arrowhead).

• 

  Figure 3 Histopathologic features of the affected upper anterior gingiva. (A) A diffuse mixed inflammatory cell infiltrate comprising mostly neutrophils that formed micro-abscesses. Also evident is the presence of fibrinoid vasculitis. (B) This image shows palisading granulomas and fibrinoid vasculitis. (A, B: H&E staining)

• 

  Figure 4 An image showing the dramatic improvement in the patients’ ulcerative facial lesions and gingivae following treatment. The exposed alveolar bone has been covered with mucosa (arrowhead).

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