Oral pemphigoid masquerading as necrotizing ulcerative gingivitis in a child.
BACKGROUND
Cicatricial pemphigoid (benign mucous membrane pemphigoid) is an autoimmune vesiculobullous disease that affects mucosal tissues of adults and rarely presents in children. Only 9 cases in the English literature have reported cicatricial pemphigoid in children, primarily as oral mucosal lesions. This paper presents a case of childhood cicatricial pemphigoid that clinically manifested as necrotizing ulcerative gingivitis (NUG).


METHODS
A 9-year-old girl presented with gingival bleeding and discomfort for 2 weeks. NUG was suspected and the patient was treated with antibiotics and an oral hygiene regimen. When the condition did not improve after repeated treatment trials, routine hematoxylin and eosin (H&E) and direct immunofluorescence examinations were performed.


RESULTS
Microscopic examination of H&E stained sections showed a non-specific ulceration with chronic inflammation. Direct immunofluorescence studies of peri-lesional tissue showed linear deposition of C3 at the basement membrane zone that was consistent with a diagnosis of cicatricial pemphigoid.


CONCLUSIONS
Cicatricial pemphigoid is an autoimmune ulcerative condition that is rarely seen in children. Immunofluorescence studies are essential to differentiate this condition from other ulcerative oral lesions.
Musa
Nour J
NJ
Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, NY 14214, USA. neiders@buffalo.edu
Kumar
Vijay
V
Humphreys
Lewis
L
Aguirre
Alfredo
A
Neiders
Mirdza E
ME
D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D005882:Gingival Diseases / Q000473:pathology*; D005892:Gingivitis, Necrotizing Ulcerative / Q000175:diagnosis; D006801:Humans; D010390:Pemphigoid, Benign Mucous Membrane / Q000473:pathology*