A case of granulomatosis with polyangiitis accompanied with strawberry gingivitis, and a review of the literatures. Issue 1 (2nd January 2018)

• Record Type: Journal Article
• Authors: Tokuda, Yukiko; Ono, Nobuyuki; Sakai, Mariko; Sadanaga, Yuri; Maruyama, Akihito; Suematsu, Rie; Koarada, Syuichi; Kimura, Hiromi; Shimohira, Daiji; Tada, Yoshifumi
• Is Part Of: Modern rheumatology case reports. Volume 2:Issue 1(2018)
• Page Start: 68
• Page End: 74
• Publication Date: 2018-01-02
• Subjects: Granulomatosis with polyangiitis -- swollen gums -- strawberry gingivitis -- proteinase 3 anti-neutrophil cytoplasmic antibody -- vasculitis; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1080/24725625.2017.1341011
• Languages: English
• ISSNs: 2472-5625

Abstract

Abstract: Hyperplastic granular gingivitis, also known as "strawberry gingivitis" (SG), is a characteristic oral presentation of granulomatosis with polyangiitis (GPA). We report a case of a 38-year-old woman who complained of swollen gums, which had an over-ripe strawberry appearance. Examination revealed pulmonary involvement and a positive finding for proteinase 3 anti-neutrophil cytoplasmic (PR3-ANCA) antibody. A gingival biopsy showed granulomatous infiltration, neovascularisation, inflammatory cell infiltration and pseudoepitheliomatous hyperplasia. These clinical features suggested a diagnosis of GPA. A moderate dose of systemic corticosteroids and methotrexate was effective. To confirm her diagnosis, we conducted a literature review of SG accompanied with GPA. The physical and pathological presentations of SG were typical for GPA. Most cases were positive for PR3-ANCA. Some showed pathological proof of vasculitis with granulomatous formations, suggesting that SG is a typical feature of GPA. Most reviewed cases were classified as being localised or at the early systemic stage, and required less intensive treatment and resulted in a favourable outcome. The findings suggest that SG is an early manifestation of GPA, and GPA should be considered for patients who present with swollen gums.