1
|
Kana T, Kawamj A, Shamim Z, Rengarajan H. Melkersson-Rosenthal Syndrome: A Case Report With a Bipolar Perspective. Cureus 2023; 15:e35955. [PMID: 37038569 PMCID: PMC10082672 DOI: 10.7759/cureus.35955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
Melkersson-Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous condition that presents with orofacial swelling, facial paralysis, and a fissured tongue. These classic triad of symptoms, however, very rarely present simultaneously. The symptoms are often seen alone or in pairs and appear at any stage in life. Although the etiology of this condition is unknown, various contributing factors have been suggested including infections, immune deficiencies, stress, and genetic predispositions. We present a case of a 23-year-old female patient who has a longstanding history of MRS, anxiety, and depression, and who attempted to overdose on prescription medications due to suicidal ideations.
Collapse
|
2
|
Joshi S, Mawdsley J, Hullah E, Ormond M, Carey B. Management of orofacial granulomatosis. Br J Hosp Med (Lond) 2023; 29:1-16. [PMID: 36989148 DOI: 10.12968/hmed.2022.0416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Orofacial granulomatosis is a chronic relapsing-remitting inflammatory condition that shares a similar phenotypic presentation to some other granulomatous diseases, particularly Crohn's disease. However, subtle clinical and pathological differences justify it as a separate disease entity. Previous studies have assessed the effectiveness of interventions used in the management of orofacial granulomatosis. This article reviews the management options available. A literature search was conducted to identify studies, in English, which assessed the effect of non-pharmacological and pharmacological interventions in the treatment of orofacial granulomatosis. The interventions were categorised into dietary modification, pharmacological (topical, intralesional and systemic therapy), surgery and psychological. A combination of interventions is often required to effectively manage each patient. There is convincing evidence that diet plays a role in disease severity. In patients where dietary manipulation alone is unsuccessful, topical, intralesional and/or systemic treatment may be considered to manage the condition.
Collapse
Affiliation(s)
- Sandeep Joshi
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joel Mawdsley
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Esther Hullah
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Martyn Ormond
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Barbara Carey
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
3
|
Cassinotti A, Batticciotto A, Parravicini M, Lombardo M, Radice P, Cortelezzi CC, Segato S, Zanzi F, Cappelli A, Segato S. Evidence-based efficacy of methotrexate in adult Crohn's disease in different intestinal and extraintestinal indications. Therap Adv Gastroenterol 2022; 15:17562848221085889. [PMID: 35340755 PMCID: PMC8949794 DOI: 10.1177/17562848221085889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/18/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Methotrexate (MTX) is included in the therapeutic armamentarium of Crohn's disease (CD), although its positioning is currently uncertain in an era in which many effective biological drugs are available. No systematic reviews or meta-analysis have stratified the clinical outcomes of MTX according to the specific clinical scenarios of its use. METHODS Medline, PubMed and Scopus were used to extract eligible studies, from database inception to May 2021. A total of 163 studies were included. A systematic review was performed by stratifying the outcomes of MTX according to formulation, clinical indication and criteria of efficacy. RESULTS The use of MTX is supported by randomized clinical trials only in steroid-dependent CD, with similar outcomes to thiopurines. The use of MTX in patients with steroid-refractoriness, failure of thiopurines or in combination with biologics is not supported by high levels of evidence. Combination therapy with biologics can optimize the immunogenic profile of the biological drug, but the impact on long-term clinical outcomes is described only in small series with anti-TNFα. Other off-label uses, such as fistulizing disease, mucosal healing, postoperative prevention and extraintestinal manifestations, are described in small uncontrolled series. The best performance in most indications was shown by parenteral MTX, favouring higher doses (25 mg/week) in the induction phase. DISCUSSION Evidence from high-quality studies in favour of MTX is scarce and limited to the steroid-dependent disease, in which other drugs are the leading players today. Many limitations on study design have been found, such as the prevalence of retrospective underpowered studies and the lack of stratification of outcomes according to specific types of patients and formulations of MTX. CONCLUSION MTX is a valid option as steroid-sparing agent in steroid-dependent CD. Numerous other clinical scenarios require well-designed clinical studies in terms of patient profile, drug formulation and dosage, and criteria of efficacy.
Collapse
Affiliation(s)
| | | | | | | | - Paolo Radice
- Ophtalmology Unit, ASST Sette Laghi, Varese, Italy
| | | | - Simone Segato
- Gastroenterology Unit, ASST Sette Laghi, Varese, Italy
| | | | | | - Sergio Segato
- Gastroenterology Unit, ASST Sette Laghi, Varese, Italy
| |
Collapse
|
4
|
Pathania YS. Current treatment modalities in granulomatous cheilitis. Int J Dermatol 2022; 61:755-759. [PMID: 35174873 DOI: 10.1111/ijd.16126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Granulomatous cheilitis (GC) is a poorly understood disorder of the labial mucosa, which is a subtype under an umbrella term "orofacial granulomatosis." Several treatment modalities have been tried in the management of GC with suboptimal to optimal results. OBJECTIVE The objective of this article is to discuss various treatment modalities, whether medical or surgical, that have been tried for the management of GC with success. METHODS A comprehensive literature search was performed to screen articles related to the successful treatment of GC. Articles published in journals indexed in PubMed were searched along with those in Google Scholar. There was no availability of systematic review or meta-analysis on treatment of GC in the literature search. Recent data has been collected and consolidated from various case reports and case series to provide a concise overview of various treatments applied in GC. RESULTS Various treatment modalities have been used in GC including glucocorticoids, antibiotics, immunomodulatory, and biological agents, surgical debulking, and laser therapy. No treatment modality has provided a predictable success. Intralesional corticosteroid therapy has been used more frequently either alone or in combination with other modalities.
Collapse
Affiliation(s)
- Yashdeep Singh Pathania
- Assistant Professor, Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Rajkot, Gujarat, 360110, India
| |
Collapse
|
5
|
Dhawan SR, Saini AG, Singhi PD. Management Strategies of Melkersson-Rosenthal Syndrome: A Review. Int J Gen Med 2020; 13:61-65. [PMID: 32161488 PMCID: PMC7049838 DOI: 10.2147/ijgm.s186315] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/22/2020] [Indexed: 12/23/2022] Open
Abstract
Melkerrson-Rosenthal syndrome is a rare disorder of unknown aetiology and characterized by the triad of oro-facial edema, facial nerve palsy, and furrowing of the tongue. Two or more of the above are essential for making a clinical diagnosis. The mainstay of treatment is corticosteroids. Intralesional triamcinolone acetonide may be used for the treatment of oro-facial edema. Another treatment option for oro-facial edema includes intralesional betamethasone, along with oral doxycycline. The review discusses the management strategies in Melkersson-Rosenthal syndrome.
Collapse
Affiliation(s)
- Sumeet R Dhawan
- Department of Pediatrics, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, 133207, India
| | - Arushi G Saini
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Pratibha D Singhi
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.,Medanta, The Medicity, Gurgaon, Haryana, India
| |
Collapse
|
6
|
Sutharaphan T, Chanprapaph K, Vachiramon V. Unsuccessful Treatment of Cheilitis Granulomatosa with Oral Methotrexate. Case Rep Dermatol 2019; 11:249-255. [PMID: 31616277 PMCID: PMC6792424 DOI: 10.1159/000503138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/01/2019] [Indexed: 11/19/2022] Open
Abstract
Cheilitis granulomatosa (CG) is a rare idiopathic condition with painless lip swelling, characterized by non-necrotizing granulomatous inflammation in the absence of other identifiable causes such as Crohn's disease, sarcoidosis, foreign body reaction, or infection. CG may precede the presentation of Crohn's disease after long-term follow-up. Spontaneous remission of CG rarely occurs. To date, given the rarity of CG, there is no gold standard treatment. Recommended treatments are supported by small studies, case reports/series, and expert opinions. Glucocorticoids are the first-line therapy in the acute stages of the disease; however, recurrence commonly occurs. Previously, methotrexate (MTX) showed a beneficial effect on orofacial swelling in a case of CG accompanied by Crohn's disease. We present a patient with CG without Crohn's disease. He was treated with oral MTX in combination with intralesional corticosteroid injection on one side of the lip. The injected side showed improvement, while lip swelling on the noninjected area remained unchanged after 3 months of treatment. Therefore, CG is refractory to treatment with MTX from our experience. Further studies regarding the optimum dosage of MTX is needed.
Collapse
Affiliation(s)
- Thanapon Sutharaphan
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
7
|
Hullah EA, Escudier MP. The mouth in inflammatory bowel disease and aspects of orofacial granulomatosis. Periodontol 2000 2019; 80:61-76. [DOI: 10.1111/prd.12264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Esther A. Hullah
- Faculty of DentistryOral & Craniofacial SciencesKing's College London UK
| | | |
Collapse
|
8
|
Carolino F, Fernandes M, Plácido JL. Melkersson-Rosenthal syndrome - delay in the diagnosis of an early-onset oligosymptomatic variant. Porto Biomed J 2016; 1:43-45. [PMID: 32258547 DOI: 10.1016/j.pbj.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/10/2015] [Indexed: 11/17/2022] Open
Abstract
Melkersson-Rosenthal syndrome is a rare neuro-mucocutaneous disease with a chronic intermittent course, characterized by a classic triad of orofacial swelling, fissured tongue (lingua plicata) and facial paralysis. The authors describe the case of an oligosymptomatic variant (lip and tongue involvement) with childhood onset, whose diagnosis was only established at the age of 19 years. The syndrome's pathophysiology is unclear and the treatment is challenging; corticosteroid therapy is the mainstay of treatment and is associated with clinical and histological improvement.
Collapse
Affiliation(s)
- Fabrícia Carolino
- Imunoalergology Department, São João Hospital Center, Porto, Portugal
| | | | - José Luís Plácido
- Imunoalergology Department, São João Hospital Center, Porto, Portugal
| |
Collapse
|
9
|
Nazzaro G, Muratori S, Carrera CG, Coggi A, Gianotti R. Cheilitis granulomatosa associated with lupus erythematosus discoid and treated with methotrexate: report of a case. An Bras Dermatol 2016; 90:200-2. [PMID: 26312716 PMCID: PMC4540550 DOI: 10.1590/abd1806-4841.20153762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/15/2014] [Indexed: 02/04/2023] Open
Abstract
We present the rare case of a 47-year-old patient, suffering from cheilitis
granulomatosa and lupus erythematosus discoid: this association is really exceptional
because only once reported in English literature. In addition, the treatment of
cheilitis granulomatosa is a challenge for the dermatologist: the gold standard,
represented by steroids, is in fact designed as a short-time option. Our report confi
rms the good efficacy of methotrexate as a steroid-sparing agent.
Collapse
Affiliation(s)
- Gianluca Nazzaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, IT
| | - Simona Muratori
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, IT
| | - Carlo Giovanni Carrera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, IT
| | - Antonella Coggi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, IT
| | - Raffaele Gianotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, IT
| |
Collapse
|
10
|
Abstract
Orofacial granulomatosis (OFG) is an uncommon chronic inflammatory disorder of the orofacial region. It is characterized by subepithelial noncaseating granulomas and has a spectrum of possible clinical manifestations ranging from subtle oral mucosal swelling to permanent disfiguring fibrous swelling of the lips and face. Etiopathogenesis is unknown. A range of systemic granulomatous disorders, including Crohn disease and sarcoidosis, may cause orofacial manifestations that cannot be distinguished from those of OFG. Treatment of OFG has proven difficult and unsatisfactory, with no single therapeutic model showing consistent efficacy in reducing orofacial swelling and mucosal inflammation.
Collapse
Affiliation(s)
- Arwa Al-Hamad
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK; Dental Services, Ministry of National Guard, King Abdulaziz Medical City-Riyadh, Riyadh, Saudi Arabia
| | - Stephen Porter
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK
| | - Stefano Fedele
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK; NIHR University College London Hospitals Biomedical Research Centre, Maple House, Suite A, 1st floor, 149 Tottenham Court Road, London W1T 7DN, UK; Oral Medicine Unit, Eastman Dental Hospital, University College London Hospitals Trust, 256 Gray's Inn Road, London WC1X 8LD, UK.
| |
Collapse
|
11
|
Troiano G, Dioguardi M, Giannatempo G, Laino L, Testa NF, Cocchi R, De Lillo A, Lo Muzio L. Orofacial granulomatosis: clinical signs of different pathologies. Med Princ Pract 2015; 24:117-22. [PMID: 25592641 PMCID: PMC5588207 DOI: 10.1159/000369810] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 11/11/2014] [Indexed: 12/13/2022] Open
Abstract
Orofacial granulomatosis (OFG) is an uncommon disease characterized by persistent or recurrent soft tissue enlargement, oral ulceration and a variety of other orofacial features. It could be an oral manifestation of a systemic disease. For a correct differential diagnosis, local and systemic conditions characterized by granulomatous inflammation should be excluded using appropriate clinical and laboratory investigations. In fact, the diagnosis of OFG may be confirmed only by histopathological identification of noncaseating granulomas. The literature from 1943 to 2014 was reviewed with emphasis on the etiology of OFG and on clinical manifestations of systemic pathologies associated with OFG. The precise cause of OFG is still unknown, although several theories have been suggested, such as infection, hereditary factors and allergy. OFG is a disease that has a wide spectrum of presentation, which may include the oral manifestation of a systemic condition such as Crohn's disease, sarcoidosis, granulomatosis with polyangiitis and Melkersson-Rosenthal syndrome.
Collapse
Affiliation(s)
- Giuseppe Troiano
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Mario Dioguardi
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Giovanni Giannatempo
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Luigi Laino
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | | | - Roberto Cocchi
- Unit of Maxillofacial Surgery, Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
| | - Alfredo De Lillo
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
- *Prof. Lorenzo Lo Muzio, Department of Clinical and Experimental Medicine, Foggia University, Via Rovelli, 50, IT-71122 Foggia (Italy), E-Mail
| |
Collapse
|
12
|
Ciacci C, Bucci C, Zingone F, Iovino P, Amato M. Buccal localization of Crohn's disease with long-term infliximab therapy: a case report. J Med Case Rep 2014; 8:397. [PMID: 25433368 PMCID: PMC4265509 DOI: 10.1186/1752-1947-8-397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/23/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Cheilitis granulomatosa causes persistent idiopathic lip swelling and ulceration and it can sometimes be recognized as a unique or early manifestation of Crohn's disease. Spontaneous remission is rare and with the lack of controlled trials, different therapeutic approaches have been used. Some cases have been treated with an exclusion diet in the attempt to rule out diet allergens, while the most popular treatments include antibiotics such as tetracycline and clofazimine tranilast, benzocaine topical or intralesional steroids, and cheiloplasty, with different outcomes. CASE PRESENTATION We describe the case of a 23-year-old Caucasian man, primarily diagnosed with cheilitis granulomatosa for a severe lower lip swelling, and then with Crohn's disease of the terminal ileum and anus. Treatment of Crohn's disease with an anti-tumor necrosis factor alpha agent (infliximab) successfully induced remission of both the gastrointestinal disease and the oral lesion. CONCLUSIONS Our recommendation is that physicians should be able to recognize cheilitis granulomatosa as a possible marker of a more complex systemic disease and proceed first with an accurate physical examination, and further suggest investigations of the bowel. In cases of Crohn's disease, a therapy with biological agents can be successful.
Collapse
Affiliation(s)
- Carolina Ciacci
- Gastroenterology Unit, Department of Medicine and Surgery, University of Salerno, Baronissi Campus, via S. Allende, 84081 Baronissi, Salerno Italy
| | - Cristina Bucci
- Gastroenterology Unit, Department of Medicine and Surgery, University of Salerno, Baronissi Campus, via S. Allende, 84081 Baronissi, Salerno Italy
| | - Fabiana Zingone
- Gastroenterology Unit, Department of Medicine and Surgery, University of Salerno, Baronissi Campus, via S. Allende, 84081 Baronissi, Salerno Italy
| | - Paola Iovino
- Gastroenterology Unit, Department of Medicine and Surgery, University of Salerno, Baronissi Campus, via S. Allende, 84081 Baronissi, Salerno Italy
| | - Massimo Amato
- Dentistry Unit, Department of Medicine and Surgery, University of Salerno, Baronissi Campus, via S. Allende, 84081 Baronissi, Salerno Italy
| |
Collapse
|
13
|
Kurtzman DJB, Jones T, Lian F, Peng LS. Metastatic Crohn's disease: a review and approach to therapy. J Am Acad Dermatol 2014; 71:804-13. [PMID: 24888520 DOI: 10.1016/j.jaad.2014.04.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/31/2014] [Accepted: 04/01/2014] [Indexed: 12/18/2022]
Abstract
Metastatic Crohn's disease (CD) is a rare cutaneous manifestation of CD that was first described nearly 50 years ago. Many subsequent reports have defined its most common clinical and histopathologic features. The pathogenesis underlying metastatic CD is unknown but various hypotheses exist. An established standard therapy is lacking. Owing to its rarity and nonspecific clinical presentation along with the diversity of inflammatory skin disorders that often complicate CD, the diagnosis of metastatic CD may be overlooked. This report highlights the salient features of this disorder to facilitate recognition and management of this rare dermatosis.
Collapse
Affiliation(s)
- Drew J B Kurtzman
- Division of Dermatology, University of Arizona College of Medicine, Tucson, Arizona.
| | - Trevor Jones
- Division of Dermatology, University of Arizona College of Medicine, Tucson, Arizona
| | - Fangru Lian
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona
| | - Lisan S Peng
- Division of Dermatology, University of Arizona College of Medicine, Tucson, Arizona
| |
Collapse
|
14
|
Merigo E, Fornaini C, Manfredi M, Meleti M, Alberici F, Corcione L, Buzio C, Rocca JP, Ferri T, Vescovi P. Orofacial granulomatosis treated with low-level laser therapy: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:e25-9. [DOI: 10.1016/j.oooo.2011.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 11/11/2011] [Accepted: 12/16/2011] [Indexed: 11/30/2022]
|
15
|
Banks T, Gada S. A comprehensive review of current treatments for granulomatous cheilitis. Br J Dermatol 2012; 166:934-7. [DOI: 10.1111/j.1365-2133.2011.10794.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T. Banks
- Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889‐5600, U.S.A
| | - S. Gada
- Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889‐5600, U.S.A
| |
Collapse
|
16
|
Orofacial granulomatosis: clinical study of 20 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:e12-7. [DOI: 10.1016/j.oooo.2011.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 10/14/2011] [Accepted: 10/21/2011] [Indexed: 01/20/2023]
|
17
|
Intralymphatic granulomas as a pathogenic factor in cheilitis granulomatosa/Melkersson-Rosenthal syndrome: report of a case with immunohistochemical and molecular studies. Am J Dermatopathol 2011; 33:594-8. [PMID: 21317610 DOI: 10.1097/dad.0b013e3181f04912] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Orofacial granulomatosis, an uncommon immunologically mediated disorder, includes cheilitis granulomatosa and Melkersson-Rosenthal syndrome. It is clinically characterized by recurrent or persistent swelling of the orofacial tissues with a spectrum of other orofacial features and sometimes with neurological symptoms. The pathological findings are varied but are often characterized by the presence of noncaseating granuloma. We present a new case of orofacial granulomatosis with unusual histopathological findings, namely, intralymphatic granulomas. These may be the cause of the tissue edema. We demonstrated, by immunohistochemical studies, the lymphatic nature of the vessels affected by the granulomatous process.
Collapse
|
18
|
Orofacial granulomatosis in children--a challenge for diagnosis and treatment. Int J Pediatr Otorhinolaryngol 2011; 75:864-7. [PMID: 21458863 DOI: 10.1016/j.ijporl.2011.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 03/01/2011] [Accepted: 03/06/2011] [Indexed: 12/14/2022]
Abstract
The data on orofacial granulomatosis, OFG, in children are sparse. We describe here 8 pediatric patients presenting with OFG, 2 of these cases associating with Crohn's disease. Therapeutic agents included systemic immunosuppressants such as glucocorticoids, methotrexate, anti-TNF-alpha agent, dapsone, antibiotics (metronidazole), and local treatment with topical tacrolimus or intralesional injections of triamcinolone hexacetonide. The treatment response ranged from good to poor results. The number of young patients suffering from OFG is not currently known and there are no gold standards for treatment. Thus, prospective follow-up studies on these patients are needed to gain more experience of the therapeutic responses.
Collapse
|
19
|
Macaigne G, Harnois F, Boivin JF, Dikov D, Ridoux G, Cheaib S, Chayette C. Crohn's disease revealed by a cheilitis granulomatosa with favorable evolution by perfusions of infliximab: report of a case and review of the literature. Clin Res Hepatol Gastroenterol 2011; 35:147-9. [PMID: 21809492 DOI: 10.1016/j.clinre.2010.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
20
|
Rehor G, Braun-Falco M, Nashan D, Meiss F. [Cheilitis granulomatosa as initial manifestation of Crohn's disease]. DER HAUTARZT 2009; 61:691-3. [PMID: 19953217 DOI: 10.1007/s00105-009-1853-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Cheilitis granulomatosa (CG) can be associated with many different disorders. A 37-year-old male patient presented with CG as an early manifestation of Crohn's disease. Patients suffering from CG need a thorough diagnostic work-up for associated or underlying diseases. Clinical follow-up examinations are necessary as CG can precede the causative diseases.
Collapse
Affiliation(s)
- G Rehor
- Universitäts-Hautklinik, Klinikum der Albert-Ludwigs-Universität Freiburg, Hauptstr. 7, 79104, Freiburg i. Br., Deutschland
| | | | | | | |
Collapse
|
21
|
Cheilitis granulomatosa as an early manifestation of Crohn's disease. Clin J Gastroenterol 2009; 2:190-193. [PMID: 26192294 DOI: 10.1007/s12328-009-0084-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 03/09/2009] [Indexed: 10/20/2022]
Abstract
Cheilitis granulomatosa (CG) is a rare disease, which presents usually as a persistent swelling of the soft tissues in the orofacial region and is characterized histologically by a granulomatous inflammation. We report the case of a 19-year-old man who suffered from anal fistula. The patient had a 6-year history of asymptomatic and persistent swelling of the lower lip. Examinations for gastrointestinal lesions containing double-balloon total enteroscopy revealed erosions located longitudinally throughout the small intestine and the patient was diagnosed Crohn's disease (CD). Biopsy of the lower lip showed non-caseating granuloma and confirmed the diagnosis of CG. Despite an elemental diet and mesalazine therapy, the lip swelling persisted. The CG can be the first presenting symptom of CD. CG as a complication of CD is discussed.
Collapse
|
22
|
van Steensel MAM, Badeloe S, Winnepenninckx V, Vreeburg M, Steijlen PM, van Geel M. Granulomatous rosacea and Crohn's disease in a patient homozygous for the Crohn-associated NOD2/CARD15 polymorphism R702W. Exp Dermatol 2008; 17:1057-8. [PMID: 18616576 DOI: 10.1111/j.1600-0625.2008.00753.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
NOD2/CARD15 belongs to the N-terminal caspase recruitment domain family of proteins involved in regulating NF-kB activation in response to inflammatory stimuli transduced through Toll-like receptors. Mutations and polymorphisms in the NOD2/CARD15 gene reduce antibacterial responses and are associated with granulomatous inflammatory conditions such as Blau syndrome and early-onset sarcoidosis. The polymorphism R702W (arginine to tryptophan) is strongly associated with susceptibility to Crohn's disease in Caucasian populations. Skin abnormalities (other than cutaneous manifestations of Crohn's disease) have not been previously associated with R702W. We report on a female patient homozygous for R702W who developed granulomatous rosacea at the age of 12 years old. From the occurrence in the context of Crohn associated with R702W, we speculate that granulomatous rosacea may be an entity distinct from other forms of rosacea, which are associated with increased production of antibacterial proteins such as cathelicidin.
Collapse
|