“Strawberry like” gingivitis being the first sign of Wegener's granulomatosis

Ruokonen, Hellevi; Helve, Tapani; Arola, Johanna; Hietanen, Jarkko; Lindqvist, Christian; Hagstrom, Jaana

doi:10.1016/j.ejim.2009.04.007

« Previous Next »European Journal of Internal Medicine
Volume 20, Issue 6 , Pages 651-653, October 2009

“Strawberry like” gingivitis being the first sign of Wegener's granulomatosis

Hellevi Ruokonen
- Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
Tapani Helve
- Department of Internal Medicine, Division of Rheumatology, HUS, Helsinki University Central Hospital, Helsinki, Finland
Johanna Arola
- Department of Pathology, Haartman Institute, University of Helsinki, Helsinki, Finland
Jarkko Hietanen
- Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
- Department of Oral Pathology, Institute of Dentistry, Helsinki University, Helsinki, Finland
- HUSLAB, Helsinki University Central Hospital, Helsinki, Finland
Christian Lindqvist
- Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
Jaana Hagstrom
- Department of Pathology, Haartman Institute, University of Helsinki, Helsinki, Finland
- Corresponding author. Department of Pathology, Haartman Institute, P.O. Box 21, 00014 University of Helsinki, Finland. Tel.: +358 504271914; fax: +358 919126551.

Received 17 March 2009; received in revised form 14 April 2009; accepted 25 April 2009. published online 01 June 2009.

Abstract

Wegener's granulomatosis (WG) is a rare granulomatous necrotizing vasculitis of small vessels, affecting vascular structures having predilection for upper airways. If untreated WG can be lethal. WG is also known to cause oral mucosal lesions. We report a case of WG that was first diagnosed on oral gingival mucosa.

A 51-year old woman was referred to a specialized dentist because of consistent irritative buccal gingival hyperplasia that did not react to conservative and microbial treatment. The lesion was biopsied and the diagnosis was suggestive for WG. Patient was further referred to the Department of Rheumatology and the diagnose of WG was confirmed and treated. The oral lesions cured totally. This case emphasizes the importance to recognize the oral manifestation of WG to get proper medication as soon as possible and avoid serious systemic tissue damage.

Keywords: Wegener, Gingivitis, Granulomatous disease, Vasculitis