Oral sarcoidosis: a case report and review of the literature

Abstract

Sarcoidosis is a chronic multi-system immuno-inflammatory disorder characterized by non-caseating granulomatous infiltration of affected tissues that may result in fibrosis and organ dysfunction. It generally affects genetically predisposed young adults who develop a local dysregulated cell-mediated immune response towards an undefined 'sarcoidal antigen'. From recent data, it has become evident that Propionibacterium acnes and Mycobacterium tuberculosis are the probable antigenic agents which initiate sarcoidosis. Oral sarcoidosis is rare with only about 70 cases having been reported in the literature. The purpose of this report is to present a case of oral and cutaneous sarcoidosis in a black female that was probably triggered by mycobacteria.Keywords: Mycobacterium, oral sarcoidosis, pathogenesis.Abbreviations and acronyms: ACE = angiotensin-converting-enzyme; ANA = anti-nuclear antibodies; ESR = erythrocyte sedimentation rate; MRC1 = mannose receptor; NKT = natural killer T cells; TB = tuberculosis; Th1 = T-helper-1; Th17 = T-helper-17; TNF-a = tumour necrosis factor.

Cutaneous Sarcoidosis

“…95 Mucosal disease Oral involvement of sarcoidosis is rare and morphologically can simulate cutaneous diseases with the presence of papules; nodules; erythema, including strawberry gums; and ulcerations. [100][101][102][103] Any portion of the oral cavity can be affected, and this can be the presenting sign of systemic disease. 102 Within the oral cavity, the buccal mucosa, gingiva, lips, tongue, and floor of mouth were most commonly affected, followed Cutaneous Sarcoidosis by the palate and submandibular glands.…”

A lump on the palate

“…Sarcoidosis localization in the oral cavity has been described most often in the buccal mucosa (30%), followed by the gingiva (20%), lips (16%), tongue (16%) and palate (9%). Lesions are most often solitary but can be multiple . Lesions may present as well‐circumscribed brown–red papules, submucosal nodules, ulceration, gingivitis, gingival hyperplasia or gingival recession .…”

“…Lesions are most often solitary but can be multiple. 3 Lesions may present as well-circumscribed brown-red papules, submucosal nodules, ulceration, gingivitis, gingival hyperplasia or gingival recession. 1 The salivary glands can also be affected, and present as painless swelling or salivary hypofunction.…”

Oral sarcoidosis aiding in diagnosis of underlying systemic disease

“…Sarcoidosis is a chronic, multisystemic, granulomatous disease of unknown aetiology characterised by the formation of non-caseating granulomas 1–9. Its occurrence varies globally depending on the geographic location and ethnic distribution.…”

“…Females are slightly more affected than males. It shows bimodal age distribution, involving young adults and elderly 1–3 6–9. Lungs, skin, eye and liver are commonly involved.…”