Strawberry Gingivitis Research Articles

ORAL MANIFESTATIONS OF GRANULOMATOSIS WITH POLYANGIITIS (WEGENER'S GRANULOMATOSIS): A SYSTEMATIC REVIEW

Objective The purpose of this review is to update the oral manifestations of Granulomatosis with polyangiitis. Study Design A systematic review was conducted through a comprehensive electronic search up to and including February 2021, using the search strategy determined in five electronic databases: National Library of Medicine, Washington, D.C. (MEDLINE-PubMed); Embase®; ISI Web of Science; Cochrane; and LIVIVO. Results Ninety-nine published articles were included in this review and reported a total of 126 cases of oral manifestation of GPA. The average age of the patients was 43.66 years and the most common systemic alterations were hypertension, diabetes, and renal failure. The most reported systemic signs were weight loss, fever, pulmonary alterations, and musculoskeletal involvement. Most cases had localized GPA and most had oral involvement in only one location, most prevalently gingiva, followed by oropharynx and hard palate. Predominant lesions were ulcer, followed by strawberry gingivitis, presenting painful symptoms in 73% of cases. Most prevalent biopsy site was gums, followed by palate. Conclusion Oral manifestations of GPA are predominantly symptomatic ulcer and strawberry gingivitis affecting mainly gingiva and oropharynx. Acknowledgements This study was financed by CNPq-Brazil (MCTIC Universal no 408884/2018-5), FAPEMIG and CAPES (Finance Code 001). The purpose of this review is to update the oral manifestations of Granulomatosis with polyangiitis. A systematic review was conducted through a comprehensive electronic search up to and including February 2021, using the search strategy determined in five electronic databases: National Library of Medicine, Washington, D.C. (MEDLINE-PubMed); Embase®; ISI Web of Science; Cochrane; and LIVIVO. Ninety-nine published articles were included in this review and reported a total of 126 cases of oral manifestation of GPA. The average age of the patients was 43.66 years and the most common systemic alterations were hypertension, diabetes, and renal failure. The most reported systemic signs were weight loss, fever, pulmonary alterations, and musculoskeletal involvement. Most cases had localized GPA and most had oral involvement in only one location, most prevalently gingiva, followed by oropharynx and hard palate. Predominant lesions were ulcer, followed by strawberry gingivitis, presenting painful symptoms in 73% of cases. Most prevalent biopsy site was gums, followed by palate. Oral manifestations of GPA are predominantly symptomatic ulcer and strawberry gingivitis affecting mainly gingiva and oropharynx.

Granulomatosis with polyangiitis (Wegener's granulomatosis) – oral cavity manifestations (clinical case)

Relevance. Granulomatosis with polyangiitis (Wegener's granulomatosis) is a rare disease in which oral cavity symptoms manifest as 'strawberry' gingivitis.Description of the clinical case. The paper presents early oral cavity clinical symptoms of a rare systemic disease – granulomatosis with polyangiitis with the manifestation of gingival hyperplasia in 1 patient, in the form of so-called "strawberry gingivitis", in another – a non-specific ulcer on the mucous mem-brane of the soft palate. After examination, the dentist referred the patients to a rheumatologist, who confirmed the diagnosis based on additional diagnostic methods.Conclusion. Timely initiated therapy can significantly improve the patient's quality of life and life expectancy.

Oral ulceration as a revealing sign of granulomatosis with polyangiitis

Granulomatosis with polyangiitis (GPA), formerly called Wegener's granulomatosis, is a rare systemic disease of unknown etiology that can affect all areas of the body, including the oral cavity. Typical oral manifestations present as nonspecific erosive/ulcerative lesions of the oral mucosa or appear with hyperplastic gingivitis, termed “strawberry gingivitis”. We report here a case of cheek ulceration as the first sign of recurrence of GPA in the absence of oral manifestations in the primary disease. A 37-year-old woman was referred to our oral pathology and surgery department for oral ulcerations. The patient had already been diagnosed with GOODPASTURE syndrome (pneumorenal syndrome) two years previously and treated with cyclophosphamide and Azathioprine. Its relapse and the appearance of oral manifestations made it possible to readjust the diagnosis and the treatment.

A Rare Presentation of Wegener's Granulomatosis in ENT.

Wegener's granulomatosis or Granulomatosis with polyangiitis is a rare multisystem autoimmune vasculitis disease which may become life threatening due to the various system involvement. Granular hyperplastic gingivitis, the so called "strawberry gingivitis" is a rare manifestation of this disease, yet pathognomic when present. Early diagnosis and treatment is very important.

Strawberry Gingivitis as the Presenting Manifestation of Childhood Granulomatosis with Polyangiitis.

Strawberry Gingivitis as the Presenting Manifestation of Childhood Granulomatosis with Polyangiitis.

Granulomatosis with polyangiitis presenting with strawberry gingivitis

Granulomatosis with polyangiitis presenting with strawberry gingivitis

Granulomatosis with polyangiitis in gingiva: A rare case of isolated presentation.

Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease characterized by necrotising granulomatous inflammation of upper and lower respiratory tract, vasculitis and glomerulonephritis. This ailment may present with cough, haemoptysis, sinusitis, nasal deformity, skin lesions, malaise, fever, anorexia, and weight loss. Oral manifestation includes strawberry gingivitis, which is a pathognomonic clinical presentation. Here, we present a case of GPA in gingiva as the first manifestation. Clinical examination of the oral cavity revealed granular, erythematous gingival enlargement in the lower anterior teeth region involving papilla, marginal and attached gingiva with shiny and pebbled surface. Histopathological examination showed pseudoepitheliomatous hyperplasia with vasculitis and inflammation in the connective tissue, neutrophilic infiltration and abscess formation with haemorrhage were noted. Laboratory investigations revealed Proteinase 3 (PR3) antigen and Glomerular basement membrane (GBM) antigen were positive. Clinical, histopathological and laboratory investigations enabled the diagnosis of Granulomatosis with Polyangiitis. We present this rare case report of GPA with primary manifestation in gingiva.

A case report of granulomatosis with polyangiitis (GPA) – A rare presentation of strawberry gingiva to dentists and oral and maxillofacial surgeons

We present a case of isolated strawberry gingivitis without systemic involvement in an otherwise healthy young male.Early recognition and biopsy allowed for successful management of the lesion and initiation of systemic therapy for the Granulomatosis with polyangiitis (GPA), with no recognised end-organ damage.The key learning points include having a low threshold for biopsy and early referral to an oral and maxillofacial surgeon with a view to prompt assessment and commencement of treatment with planned long term follow up.

Oral lesions in Granulomatosis with polyangiitis (GPA): An updated overview

Aims Granulomatosis with polyangiitis (GPA) is one of the three primary systemic autoimmune vasculitis associated with anti-neutrophil cytoplasmic antibodies. In particular, GPA is characterized by inflammation of small and medium-sized blood vessels that may affect different organs, such as kidneys, lungs and, most commonly, upper respiratory tract. Lesions of the oral cavity, are represented by a group of non-specific lesions that include deep ulcers of tongue, cheek and palate with the presence of oro-antral fistulae, osteonecrosis of hard palate and labial mucosal nodules. However, the most pathognomonic GPA oral lesion is the so called “strawberry” gingival hyperplasia, a gingival swelling of reddish colour with scattered darker petechiae. Generally, such lesions are present in about 6-13 % of GPA patients; however, the recognition of oral lesions can help in establishing early diagnosis and treat the disease avoiding severe systemic involvement. Methods A literature review consisting of a thorough literature search was performed. Granulomatosis with polyangiitis (GPA) and oral lesions publications were selected from PubMed/Medline. The following keywords and MeSH headings were used for the search strategy: Granulomatosis with Polyangiitis, Wegener granulomatosis, antineutrophil cytoplasmic antibody associated vasculitis, mouth lesions, and strawberry gingivitis. Results Clinical and radiological features are important tools in early diagnosis, but mucosal biopsies of the upper respiratory tract are still the “gold standard” of GPA. Proper diagnosis is mandatory in order to successfully treat the pathology. Conclusions These findings underscore the importance of performing a complete oral examination, along with complete anamnesis and clinical evaluation, in all patients in whom GPA is suspected.

From strawberry gingivitis to palatal perforation: The clinicopathological spectrum of oral mucosal lesions in granulomatosis with polyangiitis

Reports of oral manifestations of granulomatosis with polyangiitis (GPA) usually refer to single-case reports; "strawberry gingivitis" has been increasingly reported. To study the clinicopathological findings of four patients in which the diagnosis of GPA was suspected from the observation of their oral lesions and compare these to existent data. Retrospective study of a case series. One patient presented typical "strawberry gingivitis" with localized disease and negative ANCA results. Two patients presented rapidly growing oral ulcers associated with systemic compromise and high ANCA levels. One patient presented with a chronic granulomatous lesion that leaded to palatal perforation. Oral manifestations of GPA may vary from rapidly evolving lesions in acutely ill patients to chronic and locally destructive lesions in slowing developing disease. These differences are also evident in the histopathological findings.

Strawberry gingivitis – First sign of Wegener's granulomatosis

Wegener's Granulomatosis (WG) is an immunologically mediated rare multisystem disease characterized by necrotizing granulomatous inflammation affecting the upper and lower respiratory tracts, disseminated vasculitis and glomerulonephritis. WG oral lesions are reported to occur in 6%–13% of patients; they were an initial presenting feature in only 2% of cases. A case of strawberry gingivitis as the first sign of WG presented with erythematous and painful localized gingival enlargement affecting the maxillary anterior region of jaw in a 17-year-old boy is reported here. Correlation of histopathology with routine hematoxylin and eosin and special stains such as Grocott-Gomori's methenamine-silver nitrate and periodic acid–Schiff, peripheral blood smear, chest radiographs, Mantoux test and clinical presentation were established in diagnosing this rare entity. By the above-mentioned procedures, we arrived at the diagnosis of WG. The aim of reporting this case was to emphasize that, the dental surgeon often being the first person to examine the oral cavity, should be familiar with the typical appearance of gingiva as “strawberry gingivitis,” its clinical course, diagnostic parameters and adequate management of WG.

Granulomatosis with polyangiitis(wegener’s granulomatosis); an important rare differential diagnosis for generalized hyperplastic gingivitis.

Granulomatosis with polyangiitis (GPA) formerly known as Wegener’s granulomatosis is a rare lifethreatening disease which can affect multiple organs of the body including oral cavity. The oral manifestation of GPA has been named as strawberry gingivitis due to its characteristic features. We report a case of GPA in a 68-year-old lady who presented with Strawberry gingivitis as the initial symptom and successfully managed with prednisone and cyclophosphamide. This case demonstrates an orofacial manifestation of a systemic disease which emphasises the importance of awareness of this kind of manifestations among dental professionals in order to facilitate early diagnosis. Key words: Anti neutrophil cytoplasmic antibody, Granulomatosis with polyangiitis, Strawberry gingivitis.

Granulomatosis with polyangitis (WEGENER’S)- Strawberry gingivitis as prime manifestation

Wegener's granulomatosis (WG) is an immunologically mediated inflammatory disease. Major histological features include a necrotizing vasculitis involving small vessels, extensive “geographic” necrosis, and granulomatous inflammation. Clinical manifestations of WG are protean; virtually any organ can be involved. Further, the spectrum and severity of the disease is heterogeneous, ranging from indolent disease involving only one site to fulminant, multiorgan vasculitis leading to death. This case report documenrts the importance of considering Wegner’s granulomatosis in patients with unique gingival lesions. The most common presenttion is a friable-granular-hyperplastic gingivitis associated with alveolar resorption and tooth mobility. The disease may remain localized to the mouth for several weeks or months before multiorgan involvement occurs. Gingival enlargement is a direct manifestation of Wegener granulomatosis, and it may be pathognomonic. Failure to recognize the clinical lesions can result in delayed diagnosis and treatment, with potentially fatal results. Therefore, the aim of reporting this case was to emphasize that, the dental surgeon often being the first person to examine the oral cavity, should be familiar with the typical appearance of gingival WG as “strawberry gingivitis,” its clinical course as well as diagnostic parameters and adequate management. Keywords: Strawberry gingivitis, Wegener's granulomatosis, Antineutrophil cytoplasmic bodies, Geographic necrosis.

Diagnosis of plasma cell gingivitis from a dental referral of ‘strawberry gingivitis’: the diagnostic challenges associated with the diagnosis and treatment of plasma cell gingivitis

Background: Plasma cell gingivitis [PCG] is a rare benign condition of the gingivae which histopathological highlights a diffuse and massive infiltration of plasma cells into the sub-epithelial gingival tissue. It is characterised clinically by sharply oedematous and erythematous gingivae which is often painful. It may be related secondary in reaction to specific medications, antigens and may highlight an underlying systemic disease. (1)

Strawberry gingivitis as the first sign of wegener’s granulomatosis: a case report

Strawberry gingivitis as the first sign of wegener’s granulomatosis: a case report

Oral manifestations of granulomatosis with polyangiitis - Clinical and radiological assessment

Background/purposeGranulomatosis with polyangiitis (GPA) is a type of primary systemic vasculitis associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA). GPA mainly affects medium and small vessels and may manifest in different organs, most commonly upper respiratory tract. Oral lesions occur in 6–13% of GPA patients and might be the first symptom observed by the patient. This study presents the evaluation of orofacial manifestations of patients with GPA. Materials and methodsProspective study was conducted between June 2014 and November 2017 in Department of Allergy and Immunology at University Hospital in Krakow. Patients diagnosed with GPA, after medical assessment, were examined including precise dental inspection, bacterial and fungal flora of oral cavity evaluation and Cone Beam Computed Tomography (CBCT) imaging. ResultsNine patients were enrolled in the study. Characteristic for GPA strawberry gingivitis was observed in one patient. Bone destruction and inflammatory lesions in paranasal sinuses was confirmed by CBCT in 55.6% of patients. Fungal infection was revealed in 66.7% of patients. ConclusionThese findings oblige dentists to consult patient with laryngologist or internal medicine physician to establish further diagnostic approach, because early diagnosis of GPA is crucial for implementing appropriate treatment and preventing chronic organ damage.

PC038: A rare case of strawberry gingivitis associated with Granulomatosis with polyangiitis – GPA (Wegener granulomatosis)

PC038: A rare case of strawberry gingivitis associated with Granulomatosis with polyangiitis – GPA (Wegener granulomatosis)

Strawberry gingivitis as the first presenting sign of Wegener's granulomatosis: Report of a case

Strawberry gingivitis as the first presenting sign of Wegener's granulomatosis: Report of a case

Two cases of granulomatosis polyangiitis presenting with Strawberry gingivitis and a review of the literature

Hyperplastic gingivitis is a rare manifestation of granulomatosis with polyangiitis (GPA). This gingivitis has a very distinctive clinical appearance (so-called Strawberry gingivitis) and when seen is virtually pathognomic for GPA. Gingivitis often precedes other organ involvement therefore making awareness of this manifestation particularly important to aid early diagnosis and treatment. Furthermore, histopathological findings of gingival specimens rarely reveal necrotizing granulomatous vasculitis, which is classically seen at other sites of involvement. As a result a delay in diagnosis is not uncommon. GPA if left untreated has a high mortality rate and early immunosuppressive treatment is associated with an improved prognosis. We present two cases of patients with GPA presenting with characteristic strawberry gingivitis and review the reported cases.

Wegener Granulomatosis with Oral Involvement as Primary Manifestation: A Case Study

Introduction: Wegener Granulomatosis is a rare multisystemic disease with an unknown cause, characterized by necrotic granulomatous lesions in respiratory tract, systemic vasculitis in small arteries and veins and necrotizing glomerulonephritis. Wegener can affect any organ including kidneys, eyes or other organs but classically affects upper and lower respiratory tract. One of the rare but important signs of this disease is oral involvement, generally occurring in 6-13% of patients, however, oral involvement as the primary manifestation of disease, occurs in only 5-6% of cases. The most common oral manifestation is strawberry gingivitis. Patients: Our patient was a 35 year-old man with gingival bleeding during brushing which began approximately 45 days before referring to the department of oral and maxillofacial diseases, Mashhad Dental School. In intraoral examination, his gingiva had a papillomatous appearance and was purple in color (strawberry appearance). Due to the presence of strawberry appearance in absence of plaque, primary diagnosis of Wegener granulomatosis was established and the patient was referred for histopathological evaluation. In laboratory tests, C-ANCA was positive and P-ANCA was negative. Finally, diagnosis of Wegener granulomatosis was confirmed and his treatment was started. Rheumatologic condition of patient's lungs was evaluated by chest X-ray and CT-scan and blood tests, biochemistry tests and urine analysis were performed for the patient. He did not have pulmonary or renal involvement. In our study, the patient was followed up after 1, 2 and 11 months from the first visit. Discussion: Up to now, few reports have been published on Wegener disease with oral involvement and in most of these articles, Wegener was diagnosed after respiratory symptoms and kidney or other organs involvement. Only in few studies was Wegener diagnosis confirmed on the basis of oral symptoms and gingival involvement. Immediate and aggressive administration of immunotherapy treatments are required due to the fatal nature of the disease as the survival rate of patients with untreated WG is low and 90% of these patients die within 1 year after respiratory or kidney involvement .