title: Oral pemphigoid masquerading as necrotizing ulcerative gingivitis in a child.
abstract: 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.
authors.affiliation: Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, NY 14214, USA. neiders@buffalo.edu
authors.forename: Nour J
authors.initials: NJ
authors.lastname: Musa
authors.forename: Vijay
authors.initials: V
authors.lastname: Kumar
authors.forename: Lewis
authors.initials: L
authors.lastname: Humphreys
authors.forename: Alfredo
authors.initials: A
authors.lastname: Aguirre
authors.forename: Mirdza E
authors.initials: ME
authors.lastname: Neiders
mesh_terms: 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*