Bluish Discoloration of Periodontal Tissue

Abstract

patient were recurrent spastic abdominal cramps and colic pains, fatigue and severe muscle weakness and dark bluish discoloration of periodontal tissue. The leading differential diagnoses could accordingly include (1) lead poisoning (2) hypoadrenocorticism (Addison's disease) (3) AIDS (Kaposi sarcoma) (4) bismuth stomatitis and (5) smoker’s melanosis. A case with severe fatigue, muscle weakness, abdominal pain, and abnormal discolorations is suggestive of Addison’s disease. However, such cases are hypotensive with diffuse pigmentation on the other parts of the body rather than oral cavity (1,2). Deposition of heavy metals (lead, bismuth, mercury, silver, gold, etc.) is tended to create discolorations in oral cavity due to reaction between sulfur ions released by oral bacteria with circulating metal molecules (3). There are other causes of bluish discolorations in oral cavity, which are summarized in table 1 (2,4-18). Approach: As the first step to diagnose, complete blood count, peripheral blood smear and blood lead level (BLL) assays are recommended. Laboratory tests of this patient revealed hypochromic microcytic anemia (Hb <10 mg/dL), basophilic stippling on blood smear and a high blood lead level (840 μg/dL). This is consistent with lead poisoning. To assess the level of target organ damages, urinalysis, routine serum biochemistries and liver function tests (LFT) are required. Radiographic imaging helps to substantiate the diagnosis in doubtful cases by showing increased metaphyseal density of long bones (lead lines) (11). In this patient, a marginal increase in serum creatinine (1.4 mg/dL) was detected. LFT and serum biochemistries were normal Treatment: Primarily, the exposure should be decreased. The mainstay of treatment of lead poisoning is chelation therapy. However, it is only indicated for symptomatic patients with BLL exceeding 70 μg/dL in adults and 45 μg/dL in WWWWWWWWWWWWWWWWWWW ASIA PACIFIC JOURNAL of MEDICAL TOXICOLOGY APJMT 1;1 www.mums.ac.ir/j-apjmt DECEMBER, 2012