Immunopathological diagnosis of cicatricial pemphigoid with desquamative gingivitis. A case report

Cicatricial pemphigoid (CP) is a chronic subepidermal bullous dermatosis which primarily involves the mucous membranes. The oral cavity and the eye are most frequently involved. Since extension of the lesion into the pharynx and esophagus causes sore throat and dysphagia and progressive ocular lesions may cause blindness, early and valid diagnosis is very important. Here we present a case of cicatricial pemphigoid with onset at age 45 in a patient who manifested severe periodontal disease and showed the lesion on the mucous membranes of the mouth (desquamative gingivitis), skin, and eyes. Since definite diagnosis is very important, we describe how we made a differential diagnosis from other diseases which also accompany desquamative gingivitis. We examined the clinical manifestations, blood test results, HLA-genotype, histopathologic findings of the affected tissue, and immunological findings in relation to autoimmunity. Since many of the CP cases are first referred to periodontists or dentists, we believe that the diagnostic strategy described in the present study will be quite informative for making rapid and definite diagnoses of similar cases.     

Desquamative gingivitis: preliminary observations with tetracycline treatment

Fourteen patients admitted to our clinic were found to have desquamative gingivitis. They were treated with doxycycline monohydrate, a semisynthetic tetracycline, for 6 to 8 weeks. The gingival lesions were recorded photographically and were classified according to severity by means of a four-graded mucosal index system. Biopsies for histologic and immunohistochemical examination were taken initially. Symptoms and clinical changes of the mucosa were recorded during the treatment period. Initial and final mucosal index scores were compared. A statistically significant improvement was obtained after tetracycline treatment.     

Desquamative gingivitis responding to treatment with tetracycline: a pilot study

We experienced remarkable regression of clinical signs and symptoms in three patients suffering from desquamative gingivitis, after treatment with 100 mg doxycycline monohydrate daily for 8 wk. The possible role of plaque substances as etiologic factors in the development or maintenance of desquamative gingivitis is postulated.     

Desquamative gingivitis responding to treatment with tetracycline: a pilot study

Abstract – We experienced remarkable regression of clinical signs and symptoms in three patients suffering from desquamative gingivitis, after treatment with 100 mg doxycycline monohydrate daily for 8 wk. The possible role of plaque substances as etiologic factors in the development or maintenance of desquamative gingivitis is postulated.     

Adult orthodontic treatment: a challenging case report

The case of a 61-year-old woman with a primary diagnosis of spondyloepiphyseal dysplasia and severe maxillary and mandibular spacing as well as anterior and posterior crossbites is presented. Clinical findings led to a diagnosis of macroglossia which required partial glossectomy in addition to comprehensive orthodontic treatment to correct malocclusion.     

Bullous pemphigoid: a case report

A case of bullous pemphigoid which presented initially in the mouth is described in an 82 year old male. Differential diagnosis is discussed.     

Ligneous gingivitis associated with plasminogen deficiency: a challenge in diagnosis

Abstract A 66‐year‐old female presented with gum bleeding and soreness. Her medical history was significant for delayed wound healing, which appeared to cause blindness in her right eye. A gingival incisional biopsy revealed replacement of fibrous connective tissue by an amorphous and eosinophilic material. Direct immunofluorescent staining for antibodies was negative. After the differential diagnosis of ligneous gingivitis (LG) was rendered, the activity and antigenic level of plasminogen was tested and found to be significantly decreased. Partial improvement was observed within 1 year following a regimen of scaling, gingival curettage, topical steroids, and improved oral hygiene. LG is a rare condition, occurring as a result of plasminogen deficiency and subsequent fibrin accumulation. It presents as pseudomembranous gingiva and might affect the eyes and other organs. Dentists should be familiar with this condition, since they might assist in a diagnosis of this disease, with significant morbidity often missed by medical professionals.     

Use of anti-inflammatory medications in managing atypical gingivitis associated with hypermobile Ehlers-Danlos syndrome: a case report

BACKGROUND: Ehlers-Danlos syndrome (EDS) is a group of collagen disorders primarily affecting the skin and joints. This case report describes the periodontal management of a case of hypermobile EDS (type III) associated with atypical gingivitis. METHODS: A 17-year-old Caucasian female with a history of EDS type III presented with erythematous mucogingival lesions. An incisional biopsy was taken. The treatment objective was to control the mucogingival inflammatory lesions. Plaque control measures were followed with anti-inflammatory medications. Prednisone was administered systemically for 3 weeks (first week: 30 mg/day, second week: 15 mg/day, and third week: 5 mg/day), and was followed with topical applications of clobetasol (0.05%) twice daily for 2 weeks. Persistent marginal gingival inflammation was managed with a 3-month course of doxycycline (20 mg) twice/day. The patient was placed on a 3-month maintenance program and monitored for over a year RESULTS: Histopathology showed multiple granulomas enclosing fragments of crystalline foreign material. Steriodal anti-inflammatory medications partially reduced the size and intensity of the mucogingival lesions. Doxycycline controlled the residual marginal inflammation. A 3-month maintenance interval helped in maintaining the results obtained. CONCLUSIONS: The collagen disorder may have facilitated the introduction and lodging of foreign material within the gingival tissues, initiating a foreign body reaction. Poor healing associated with EDS excluded surgical excision and necessitated the use of anti-inflammatory medications. A combined approach of plaque control measures along with anti-inflammatory medications was helpful in controlling the mucogingival inflammatory lesions associated with this condition.     

Rapidly progressive periodontitis combined with plasma cell gingivitis: a case report

A case of rapidly progressive periodontitis combined with plasma cell gingivitis with marked enlargement of the gingiva was presented. Clinically, in the plasma cell gingivitis, the gingiva appear red, friable and bleed easily; usually it does not induce loss of attachment. Histologically, a dense infiltration of the normal plasma cells in the connective tissue is a common finding. A hypersensitivity reaction to some antigens, often flavorings or spices, is generally recognized. In this case, a rapidly progressive loss of attachment was observed, so rapidly progressive periodontitis was diagnosed. Differential diagnosis of the plasma cell gingivitis could be determined by histological and ultrastructural examination. Allergens, however, could not be identified. Conventional periodontal therapy, including intensive plaque control, could not cure the plasma cell gingivitis completely but recurrence of gingival enlargement and loss of attachment could be well controlled.     

Benign mucous membrane pemphigoid: a case report.

A relatively rare systemic disease, benign mucous membrane pemphigoid (cicatricial pemphigoid) usually starts in the mouth and is clinically characterized by bullae that rupture and form an ulcer. A distinctive Nikolsky's sign is apparent using gentle air blasts or finger pressure. The pharynx, larynx, nose, esophagus, genitals and eyes can also be affected. Involvement of the conjunctivae can lead to scarring and ensuing blindness. The following case of a healthy 77-year-old man, diagnosed as suffering from mucous membrane pemphigoid, is of particular interest since several confusing clinical observations, including poor oral hygiene, the possibility of a contact dermatitis or an adverse antibiotic reaction, made the diagnosis more difficult. A careful medical history, examination and consultation process is paramount to initiating proper treatment and subsequent relief of symptoms. Benign mucous membrane pemphigoid must always be considered in any patient with desquamative epithelium of the oral mucosa.     

Streptococcal gingivitis: a report of case with a description of a unique gingival prosthesis

Acute streptococcal gingivitis is an acute inflammation of the oral mucosa. Specific bacterial infections of the gingiva may be due to neisseria gonorrhea, treponema pallidum, streptococci, and other organisms. Streptococcal infections are seen rarely. This case report describes a patient who presented with severe gingival inflammation and pain that was diagnosed as an acute streptococcal infection. Bacterial cultures were obtained from the lesion, and biopsies were obtained from the gingiva of lower incisors for histopathologic evaluation. The patient was successfully treated using conventional periodontal therapy (scaling, root planning, curettage) and antibacterial agents. The reconstructive phase for this patient consisted of the fabrication of a heat-cured acrylic gingival facade to mask the gingival recession. The treatment of acute gingivostomatitis is of importance because of the possibility of systemic secondary infections. When esthetics is important, a gingival prostheses can be considered. The differential diagnosis, etiology, and treatment of acute streptococcal gingivitis are discussed and the literature is reviewed in this report.     

Clear cell odontogenic carcinoma: case report with immunohistochemical findings adding support to the challenging diagnosis

Clear cell odontogenic carcinoma (CCOC) is a rare odontogenic tumor associated with aggressive clinical behavior, metastasis, and low survival. We report a case of CCOC affecting the mandible of a 39-year-old man. The tumor presented a biphasic pattern composed of clear cell nests intermingled with eosinophilic cells and separated by collagenous stroma. Immunoreactivity to cytokeratin (CK), specifically AE1/AE3 and CK 8, 14, 18, and 19 was found, as well as to epithelial membrane antigen (EMA). The tumor cells were negative for S100 protein, CK 13, vimentin, smooth muscle actin, laminin and type IV collagen. Low labeling indices for the proliferation markers Ki-67 and proliferating cell nuclear antigen and to p53 protein might predict a favorable prognosis for the lesion. A surgical resection was performed, followed by adjuvant radiotherapy. A 2-year follow-up has shown no signs of recurrence. The significance of histochemical and immunohistochemical resources in the correct diagnosis of CCOC is analyzed.     

Childhood oral pemphigoid: a case report and review of the literature

Oral pemphigoid, defined as cicatricial pemphigoid limited to the oral cavity, is a clinical subset of cicatricial pemphigoid. Like cicatricial pemphigoid, it occurs mostly in middle-aged women and it is uncommon in children under 20 years of age. There are 11 cases of childhood cicatricial pemphigoid published previously in the English language literature, and four of them are oral pemphigoid patients. We present a case of the youngest oral pemphigoid patient reported yet. Because of the rareness of cicatricial pemphigoid in children, delayed diagnosis and treatment have been shown in many cases reported earlier. Clinical awareness and early recognition are, therefore, emphasized.     

牙拔除术后高热1例

牙拔除术后发生高热较为少见,本文报道1例牙拔除术后高热,并结合相关文献对牙拔除术后高热的诊断和防治进行分析.