Granulomatosis with polyangiitis: potentially lethal gingival lesions presenting to the dentist

Abstract

Gingival pathology is a daily presentation, however a small number of systemic conditions can manifest similar to a common gingival condition and have fatal results. Dentist referred 56-year-old woman to Oral and Maxillofacial Surgery department with a 2-week medical history of gingival bleeding not responding to local measures. Biopsy showed eosinophilic infiltrate and vasculitis, and blood tests showed positive markers including cytoplasmic antineutrophil cytoplasmatic antibodies. Granulomatosis with polyangiitis is a rare disease affecting the respiratory tract, blood vessels and kidneys. Oral lesions are rarely the primary presenting feature. When left untreated, most cases are fatal within a year of diagnosis. The diagnosis can only be made when certain criteria are found, including granular oral lesions exhibiting an eosinophilic inflammatory infiltrate on biopsy. With 5% of cases showing intraoral lesions as the primary feature, it is essential that dentists have the knowledge of this rare disease to refer and not to treat as a common gingival condition.

Oral granulomatosis with polyangiitis a systematic review

“…A Medline, Web of Science, EMBASE, and ScienceDirect search was performed with 235 articles (Figure 1 ). A total of 31 case reports were included (Ah‐See et al, 1996 ; Allen et al, 1991 ; Aravena et al, 2014 ; Barrett et al, 2011 ; Bergé et al, 2000 Bhatt & Hall, 2009 ; Carter & Brizman, 2008 ; Cohen et al, 1990 ; Dhalkari et al, 2020; Eufinger et al, 1992 ; Fonseca et al, 2017 ; Genuis & Pewarchuk, 2014 ; Handlers et al, 1985 ; Hanisch et al, 2016 ; Heera et al, 2012 ; Hernández et al, 2008 ; Illes et al, 2012 ; Israelson et al, 1981 ; Kertesz et al, 2021 ; Lilly et al, 1998 ; Lustmann et al, 1994 ; Msallem et al, 2019 ; Napier et al, 1993 ; Patrick & Altman, 2019 ; Reboll‐Ferrer et al, 2010 ; Ruokonen et al, 2009 ; Siar et al, 2011 ; Sung et al, 2015 ; Thompson et al, 2018 ; Xing et al, 2011 ). Four case series (Allen et al, 1991 ; Nico et al, 2020 ; Patten and Tomecki, 1993 ; Stewart et al, 2007 ) and one prospective study (Szczeklik et al, 2019 ) were included in the analysis with an aggregate level of evidence 3b.…”

Oral and Maxillo-Facial Manifestations of Systemic Diseases: An Overview

“…Upper respiratory tract, lungs and kidneys are the most involved sites, although can affect multiple systems in the whole organism. Head and neck signs of the disease are chronic sinusitis with or without pus or bloody drainage, salivary gland swelling, nasal and oral mucosa ulcers, tongue necrosis, facial palsy, but the most reported clinical presentation is as gingival hyperplasia, most precisely a strawberry-like gingivitis/lesion of the maxilla [ 112 , 113 , 114 , 115 ]. The differential diagnosis includes angioedema, Crohn’s disease, other granulomatosis, amyloidosis, NHL (mostly NK type) and oral squamous cell carcinoma too [ 112 ].…”