C4 Staphylococcus aureus infection associated with orofacial granulomatosis

Abstract

Presenting problem: A 6‐year‐old girl attended the Department of Paediatric Dentistry at Edinburgh Dental Institute complaining of swelling and blistering of her upper lips and adjacent gingivae, which had been present for approximately 1 month. The patient had an unremarkable medical history.Clinical management: Examination revealed submandibular lymphadenopathy with vesiculation and erythema in the upper incisor region. There was swelling and crusting of the upper lip with slight swelling of the lower lip. Foetor oris was evident. An initial diagnosis of primary herpetic gingivostomatitis was made. Despite treatment the lesions did not resolve. At review, the patient's mother stated that the patient was now suffering abdominal pain and diarrhoea. Haematological investigations revealed no abnormalities. Punch biopsies of the lips carried out under general anaesthesia showed lymphoedema but no granulomata. It was felt by the pathologist that the appearance was of a secondarily infected lesion with an underlying allergic component, most likely to be orofacial granulomatosis (OFG). Swabs sent for bacterial and fungal culture identified no fungal species but Staphlycoccous aureus was present in large numbers. The patient was prescribed Nystaform® cream and oral flucloxacillin which has improved the appearance of the upper lips. The patient has been referred for patch testing, and also to gastroenterology for investigation.Discussion: Staphylococcal mucositis has been reported previously in a series of patients with OFG. This case demonstrates an unusual presentation of Staphylococcus aureus infection, previously unreported, in a child with OFG.