Strawberry-like gingival tumor as the first clinical sign of Wegener's granulomatosis.
BACKGROUND
Wegener's granulomatosis (WG) is a complex disease, characterized by a necrotizing vasculitis that usually involves the upper airways, lungs, and kidneys; occasionally, other organs may also be affected. Because of the severity and rapid progression of the disease, early diagnosis and treatment are critical; this type of vasculitis is potentially fatal if left unchecked.


METHODS
A 64-year-old woman presented with a chief complaint of a gingival mass that had appeared 2 months before and had grown rapidly. In the previous months she complained of malaise without weight loss. An intraoral examination revealed the presence of a solitary gingival mass, 2 cm in diameter, affecting the area above the upper central incisors. The lesion displayed a granular, erythematous, speckled surface with petechiae, characteristic of WG.


RESULTS
A biopsy of the lesion, a thoracic computed tomography, and the presence of high titers of antineutrophil cytoplasmic antibodies (ANCA) in the blood established the diagnosis of WG. An initial combination therapy of prednisone and cyclophosphamide successfully abated most of the patient's symptoms.


CONCLUSIONS
The occurrence of an extremely rare tumor-like form of strawberry gingiva was the primary clinical sign that led to a diagnosis of WG. This case emphasizes the important role of the dentist in the diagnosis of this potentially fatal disease.
Hernández
Gonzalo
G
Department of Oral Medicine and Surgery, School of Dentistry, Complutense University, Madrid, Spain. ghervall@odon.ucm.es
Serrano
Cristina
C
Porras
Lourdes
L
Lopez-Pintor
Rosa
R
Rubio
Lourdes
L
Yanes
Jaime
J
D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis; D001706:Biopsy; D003937:Diagnosis, Differential; D004890:Erythema / Q000175:diagnosis; D005260:Female; D005882:Gingival Diseases / Q000175:diagnosis*; D005887:Gingival Neoplasms / Q000175:diagnosis; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D011693:Purpura / Q000175:diagnosis
D019268:Antibodies, Antineutrophil Cytoplasmic