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Pillay SS, Nune A, Manzo C, Barman B, Raza H. A case of anti-neutrophil cytoplasmic antibody-associated vasculitis masquerading as Sjögren syndrome. Int J Rheum Dis 2023; 26:2555-2558. [PMID: 37427846 DOI: 10.1111/1756-185x.14823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/02/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA) -positive vasculitis is a small-vessel vasculitis that affects multiple body systems. Salivary gland involvement in ANCA-associated vasculitis is rare. When present, it mimics infection or malignancy, which might lead to misdiagnosis. In this report, we describe a 72-year-old man who presented with parotid and submandibular gland pain and swelling in addition to dry mouth and eyes. He had bilateral non-tender parotid gland lumps and no lymphadenopathies. Laboratory tests were positive for ANCA, hematuria, and proteinuria but negative for Anti-Ro and -La. He was treated with corticosteroids and cyclophosphamide for acute kidney injury. Unfortunately, the patient died a few months later. This case report sheds light on a rare manifestation of salivary gland involvement in ANCA-associated vasculitis that mimics Sjögren syndrome and the challenges associated with its diagnosis and treatment.
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Affiliation(s)
| | - Arvind Nune
- Southport and Ormskirk NHS Trust, Southport, UK
| | - Ciro Manzo
- Rheumatologic Outpatient Clinic, Sant'Agnello, Italy
| | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati, India
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2
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Raghavendra Prasad KU, Fida Harish AT. A Rare Presentation of Wegener's Granulomatosis in ENT. Indian J Otolaryngol Head Neck Surg 2023; 75:2363-2366. [PMID: 37636710 PMCID: PMC10447330 DOI: 10.1007/s12070-023-03653-0] [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: 07/15/2022] [Accepted: 02/27/2023] [Indexed: 08/29/2023] Open
Abstract
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.
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Affiliation(s)
| | - A. T. Fida Harish
- Department of ENT, Hassan Institute of Medical sciences, Hassan, India
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3
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Lorenzon M, Spina E, Tulipano Di Franco F, Giovannini I, De Vita S, Zabotti A. Salivary Gland Ultrasound in Primary Sjögren’s Syndrome: Current and Future Perspectives. Open Access Rheumatol 2022; 14:147-160. [PMID: 36072437 PMCID: PMC9444027 DOI: 10.2147/oarrr.s284763] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/24/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Michele Lorenzon
- Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy
- Correspondence: Michele Lorenzon, Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy, Tel +39 0432 559232, Email
| | - Erica Spina
- Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy
| | | | - Ivan Giovannini
- Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Udine, Italy
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4
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Pomorska A, Świętoń D, Lieberman SM, Bryl E, Kosiak W, Pęksa R, Chorążewicz J, Kochańska B, Kowalska-Skabara J, Szumera M, Brzoznowski W, Jaworski R, Irga-Jaworska N. Recurrent or persistent salivary gland enlargement in children: When is it Sjögren's? Semin Arthritis Rheum 2021; 52:151945. [PMID: 35000785 DOI: 10.1016/j.semarthrit.2021.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/23/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe characteristic features in children with recurrent or persistent salivary gland enlargement and to propose a diagnostic algorithm with specific consideration for Sjögren's disease (SD). METHODS In this single-center, prospective study, 45 patients < 18 years, with recurrent or persistent salivary gland enlargement of unknown etiology were enrolled from 2006 to 2019. We collected detailed clinical information to characterize this group of patients including specific details of their major salivary gland signs and symptoms. We compared clinical, laboratory and radiological parameters between 4 groups based on the results of labial salivary gland biopsy (LSGB) and between patients who met existing SD criteria or not. RESULTS 44 patients, with a mean age of 6.8 years and female to male ratio 21:23 were observed over a mean of 3.8 years. Characteristics of salivary gland swelling episodes varied considerably between individuals, but the majority experienced ≤5 episodes per year, lasting ≤ 1 week, with swelling affecting either or both glands. Ocular and oral dryness symptoms were observed only in 25% and 59% patients, respectively. The majority were positive for ANA, but negative for SD-specific antibodies. A total of 75% patients fulfilled at least one of the existing SD criteria. CONCLUSION SD is a major cause of recurrent salivary gland enlargement in children. For children meeting adult criteria, the diagnosis of SD is clear. However, for the many children without dryness symptoms, objective dryness, or SD-specific antibodies, further workup including a combination of salivary gland imaging and histopathological examination can help establish the diagnosis of SD.
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Affiliation(s)
- Anna Pomorska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, Dębinki 7, Gdańsk 80-952, Poland.
| | - Dominik Świętoń
- 2nd Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Scott M Lieberman
- Division of Rheumatology, Allergy, and Immunology, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, IA, United States
| | - Ewa Bryl
- Department of Pathology and Experimental Rheumatology, Medical University of Gdańsk, Gdańsk, Poland
| | - Wojciech Kosiak
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, Dębinki 7, Gdańsk 80-952, Poland
| | - Rafał Pęksa
- Pathology Department, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Barbara Kochańska
- Department of Conservative Dentistry, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Małgorzata Szumera
- Department of Pediatrics, Gastroenterology, Hepatology and Nutrition, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Radosław Jaworski
- Department of Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, Dębinki 7, Gdańsk 80-952, Poland
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5
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Guzman-Soto MI, Kimura Y, Romero-Sanchez G, Cienfuegos-Alvear JA, Candanedo-Gonzalez F, Kimura-Sandoval Y, Sanchez-Nava DA, Alonso-Ramon I, Hinojosa-Azaola A. From Head to Toe: Granulomatosis with Polyangiitis. Radiographics 2021; 41:1973-1991. [PMID: 34652975 DOI: 10.1148/rg.2021210132] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic antibody-associated vasculitis. It is an uncommon multisystem disease involving predominantly small vessels and is characterized by granulomatous inflammation, pauci-immune necrotizing glomerulonephritis, and vasculitis. GPA can involve virtually any organ. Clinical manifestations are heterogeneous and can be classified as granulomatous (eg, ear, nose, and throat disease; lung nodules or masses; retro-orbital tumors; pachymeningitis) or vasculitic (eg, glomerulonephritis, alveolar hemorrhage, mononeuritis multiplex, scleritis). The diagnosis of GPA relies on a combination of clinical findings, imaging study results, laboratory test results, serologic markers, and histopathologic results. Radiology has a crucial role in the diagnosis and follow-up of patients with GPA. CT and MRI are the primary imaging modalities used to evaluate GPA manifestations, allowing the differentiation of GPA from other diseases that could simulate GPA. The authors review the main clinical, histopathologic, and imaging features of GPA to address the differential diagnosis in the affected organs and provide a panoramic picture of the protean manifestations of this infrequent disease. The heterogeneous manifestations of GPA pose a significant challenge in the diagnosis of this rare condition. By recognizing the common and unusual imaging findings, radiologists play an important role in the diagnosis and follow-up of patients with GPA and aid clinicians in the differentiation of disease activity versus disease-induced damage, which ultimately affects therapeutic decisions. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Mahatma I Guzman-Soto
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Yukiyoshi Kimura
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Griselda Romero-Sanchez
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Jose Antonio Cienfuegos-Alvear
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Fernando Candanedo-Gonzalez
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Yumi Kimura-Sandoval
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Dulce A Sanchez-Nava
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Ingrid Alonso-Ramon
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
| | - Andrea Hinojosa-Azaola
- From the Departments of Radiology (M.I.G.S., Y.K., G.R.S., J.A.C.A., Y.K.S., D.A.S.N., I.A.R.), Pathology (F.C.G.), and Immunology and Rheumatology (A.H.A.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico 14080
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6
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Coates ML, Martinez Del Pero M. Updates in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis for the ENT surgeon. Clin Otolaryngol 2020; 45:316-326. [PMID: 32145151 DOI: 10.1111/coa.13524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/13/2020] [Accepted: 02/29/2020] [Indexed: 12/31/2022]
Abstract
ENT involvement is common in ANCA-associated vasculitis (AAV), particularly in GPA and EGPA. Early recognition and treatment is important for good outcomes, yet evidence suggests that UK ENT surgeons may not consistently recognise the early features of AAV, despite a similar incidence to vestibular schwannoma. AAV is a rapidly advancing field, with significant developments in the understanding of its pathogenesis, classification and treatment over the past decade. Relevant vasculitis mimics are also discussed with a particular focus on the increasing prevalence of vasculitis mimics driven by an increase in recreational cocaine use, as well as the emergence and reclassification of several other vasculitis mimics in the head and neck. This article reviews key recent updates in the vasculitis literature, with a particular focus on those relevant to recognition and diagnosis of AAV for the ENT surgeon. Strengths and limitations of relevant diagnostic testing are discussed, and a method of evaluation of patients with features of AAV presenting to ENT services is outlined.
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7
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Abdelghany MF, Khalaf MGA. Submandibular salivary gland involvement in granulomatosis with polyangiitis. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_15_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Miłkowska-Dymanowska J, Laskowska P, Rzuczkowski M, Białas AJ, Piotrowski WJ, Górski P. Untypical Manifestations of Granulomatosis with Polyangiitis—A Review of the Literature. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s42399-019-00083-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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9
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Bag AK, Curé JK, Chapman PR, Singhal A, Haneef Mohamed AW. Imaging of Inflammatory Disorders of Salivary Glands. Neuroimaging Clin N Am 2018; 28:255-272. [PMID: 29622118 DOI: 10.1016/j.nic.2018.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sialadenitis is among the most common conditions that affect the salivary glands. Inflammation of the salivary glands occurs as the end result of a variety of pathologic conditions, including infectious, autoimmune, and idiopathic causes. Clinically, inflammation of the salivary gland causes pain and localized swelling. The presentation may be acute or chronic, and can be recurrent. Because there is significant overlap of underlying disease mechanisms and clinical presentations, radiologic evaluation often plays a significant role in evaluation. This article is a brief review of sialadenitis, including disease mechanisms, causes, and the practical imaging of the salivary glands.
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Affiliation(s)
- Asim K Bag
- Department of Radiology, University of Alabama at Birmingham, JT N432, 619 19th Street South, Birmingham, AL 35249, USA.
| | - Joel K Curé
- Department of Radiology, University of Alabama at Birmingham, JT N432, 619 19th Street South, Birmingham, AL 35249, USA
| | - Philip R Chapman
- Department of Radiology, University of Alabama at Birmingham, JT N432, 619 19th Street South, Birmingham, AL 35249, USA
| | - Aparna Singhal
- Department of Radiology, University of Alabama at Birmingham, JT N432, 619 19th Street South, Birmingham, AL 35249, USA
| | - Atif Wasim Haneef Mohamed
- Department of Radiology, University of Alabama at Birmingham, JT N432, 619 19th Street South, Birmingham, AL 35249, USA
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10
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Marques C, Roriz M, Chabriat H, Buffon-Porcher F, Cognat E. Differential diagnosis between sarcoidosis and granulomatosis with polyangiitis in a patient with leptomeningeal, cavernous sinus and pituitary lesions. QJM 2017; 110:691-692. [PMID: 29025147 DOI: 10.1093/qjmed/hcx135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Marques
- Department of Internal Medicine and Clinical Immunology, GH Pitié-Salpêtrière, APHP, Paris
| | - M Roriz
- Department of Internal Medicine, GH Saint-Louis Lariboisière Fernand-Widal, APHP, Paris
- University Paris Diderot-Paris 7, Paris
| | - H Chabriat
- University Paris Diderot-Paris 7, Paris
- Department of Neurology, GH Saint-Louis Lariboisière Fernand-Widal, APHP, Paris
- DHU NeuroVasc Sorbonne Paris-Cité
| | - F Buffon-Porcher
- Department of Neurology, GH Saint-Louis Lariboisière Fernand-Widal, APHP, Paris
- DHU NeuroVasc Sorbonne Paris-Cité
| | - E Cognat
- Cognitive Neurology Center, GH Saint-Louis Lariboisière Fernand-Widal, Paris
- INSERM UMR-S942, INSERM, Paris, France
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11
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Jolobe OMP. Granulomatosis with polyangiitis as the differential diagnosis. QJM 2017; 110:689. [PMID: 29025115 DOI: 10.1093/qjmed/hcx133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O M P Jolobe
- Division of Medicine, Manchester Medical Society, Simon Building, Brunswick Street, Manchester M13 9PL, UK
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12
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[Swelling of the submandibular and parotid glands : A description of possible differential diagnoses]. HNO 2017; 64:333-48. [PMID: 27160691 DOI: 10.1007/s00106-016-0158-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Swelling of single or multiple major salivary glands can be caused by various local or systemic diseases. In differential diagnosis, congenital cystic or vascular malformations should be considered, as well as infectious or tumorous alterations. Salivary duct obstructions due to sialolithiasis or stenosis can cause salivary gland enlargement. Multiple systemic diseases can have manifestations in the parotid or submandibular glands. As therapy varies from cause to cause, knowledge of the different potential diagnoses is crucial.
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13
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Fonseca FP, Benites BM, Ferrari A, Sachetto Z, de Campos GV, de Almeida OP, Fregnani ER. Gingival granulomatosis with polyangiitis (Wegener's granulomatosis) as a primary manifestation of the disease. Aust Dent J 2016; 62:102-106. [PMID: 27439744 DOI: 10.1111/adj.12441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2016] [Indexed: 01/20/2023]
Abstract
Granulomatosis with polyangiitis (GPA) is a potentially lethal disease characterized by systemic necrotizing vasculitis, which affects small- and medium-sized blood vessels and is often associated with serum cytoplasmic antineutrophil cytoplasmic antibody. The upper and lower respiratory tract and kidney are the most involved sites, but oral lesions can be identified in 6-13% of the cases, whereas in only 2% of the cases, oral manifestations represent the first signal of the disease usually as gingival swellings or unspecific ulcerations. Without treatment, the mainstay of which is the combination of immunosuppressants and systemic corticosteroids, GPA may run a fatal course. In this report we describe an original case of GPA affecting a 75-year-old female patient referred to our service due to a gingival swelling with 3-month duration. Although the patient was correctly diagnosed and promptly treated, she died 3 months after the initial diagnosis.
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Affiliation(s)
- F P Fonseca
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - B M Benites
- Oral Medicine Department, Sírio-Libanês Hospital, São Paulo, Brazil
| | - Alv Ferrari
- Department of Rheumatology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Z Sachetto
- Department of Rheumatology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - O P de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - E R Fregnani
- Oral Medicine Department, Sírio-Libanês Hospital, São Paulo, Brazil
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14
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Hamburger J. Orofacial manifestations in patients with inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:826-850. [PMID: 27964791 DOI: 10.1016/j.berh.2016.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/19/2016] [Indexed: 11/16/2022]
Abstract
The main orofacial manifestation of the inflammatory rheumatic diseases is that of Sjögren's syndrome. In addition, there is a constellation of orofacial manifestations of the inflammatory rheumatic diseases, many of which are extra-articular with some constituting presenting signs of the underlying rheumatic disease. This review will discuss the orofacial manifestations in a variety of connective tissue diseases and will also allude to the oral adverse drug reactions that may occur as a consequence of therapy.
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Affiliation(s)
- John Hamburger
- Birmingham Behçet's Syndrome Centre of Excellence, Sheldon Block, Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham, B18 7QH, UK.
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15
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Almouhawis HA, Leao JC, Fedele S, Porter SR. Wegener's granulomatosis: a review of clinical features and an update in diagnosis and treatment. J Oral Pathol Med 2013; 42:507-16. [PMID: 23301777 DOI: 10.1111/jop.12030] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2012] [Indexed: 01/31/2023]
Abstract
Wegener's granulomatosis (WG) is an idiopathic, systemic inflammatory disease characterized by necrotizing granulomatous inflammation and pauci-immune small-vessel vasculitis of upper and lower respiratory tract and kidneys. The condition affects both genders equally, although some inconsistent gender differences have been observed. The aetiology of WG remains unknown although a number of exogenous factors have been suggested to be of aetiological relevance. Most clinical characteristics of this disease are non-specific, making clinical diagnosis challenging. Histopathological examination of lesional and peritoneal tissue is not pathognomonic, but is an essential investigation to confirm the presence of disease and exclude other disorders. At present, despite the increasingly wide range of potential therapies, cyclophosphamide plus corticosteroids remain the most recognized and effective means of inducing and sustaining remission of WG.
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Affiliation(s)
- Hanan A Almouhawis
- Oral Medicine unit, Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, London, UK
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