Eosinophilic granuloma in jaw bone: a pare pediatric case report

Abstract

BACKGROUND: Eosinophilic granuloma (EG), one of the three clinical forms of Langerhans cell histiocytosis (LCH), is a benign inflammatory reaction to an unknown etiologic agent. It most commonly occurs in children and young adults. The most frequently involved bones are the skull, the ribs and the femurs. Alongside the cranium, the maxilla and mandible can also be affected. CASE DETAILS: Herein, we report a case of eosinophilic granuloma in a ten years old boy involving posterior quadrants upper and lower jaws as a destructive lesion involving gingiva, periodontium and alveolar bone. Involvement of other bones is ruled out by nucleotide imaging study. CONCLUSION: EG should be considered as a differential diagnosis whenever there is a bony destructive lesion involving alveolar bone of the Jaws. Early diagnosis and surgical intervention will resolve the lesion.

Diagnosis and management of eosinophilic granuloma of the jaw: a case report

“…EG is the most common presentation and is responsible for 50% to 70% of cases of Langerhans' cell Histiocytosis, more frequently occurring as a solitary osteolytic lesion, particularly in children and young adults, and is most frequent in the first decade of life [3,5,7] which corroborates the findings of the present case. According to Atarbashi Moghadam et al [4], Langerhans' cell Histiocytosis, is a disease of unknown pathogenesis, considered rare, with a prevalence of lower than 1% in the population studied between 1992 and 2012.…”

“…The most frequent signs and symptoms of this pathology are pain, edema, ulceration, gingival necrosis, destruction of the alveolar bone with mobility and loss of teeth [3,6,7]. Depending on the bone destruction of the maxillae, it may lead to pathological fractures [3,7].…”

“…Extensive involvement of the alveolar bone may result in the appearance of teeth "floating in the air" [1,6,8]. In these cases teeth may be observed with the presence of mobility and deep periodontal pockets, mucosa with ulcerative or proliferative lesions, with erythema and severe tendency to bleeding on probing [7]. These clinical and radiographic characteristics resemble those of aggressive periodontal diseases [1,2,4,5], and therefore, it is important to perform differential diagnosis by means of specific clinical findings, evolution of the pathology and biopsy for histopathological exam.…”

“…The chronic form of this pathology is associated with the presence of a triad of with their own characteristics, which include osteolytic lesions, exophthalmia and insipid diabetes [5,7,9].…”

“…The therapeutic options for the treatment of EG are surgical removal by means of curettage, radiotherapy in low doses, chemotherapy, intralesional injection of steroids for reduction in size of the lesion followed by curettage, and depending on the case, there are reports of spontaneous resolution of the lesion [3,7,8]. Moreover, for confirmation of the diagnosis, incisional biopsy and histopathological analysis [6] are necessary, because from the clinical characteristics of the lesion, it may present differential diagnosis from other pathologies, such as osteomyelitis, carcinoma, sarcoma, lymphoma, Paget's disease, multiple myeloma and Papillon-Lefèvre Syndrome [3,6,8].…”