title: Refractory chronic spontaneous urticaria and permanent atrial fibrillation associated with dental infection: Mere coincidence or something more to it?
abstract: Controversy surrounds the role of dental infection/inflammation in the oral cavity in chronic spontaneous urticaria (CSU) and atrial fibrillation (AF), which is mainly due to scarce literature in this area. Therefore, this case report and review of literature illustrate a possible association between the acute-phase response (APR) and clinical conditions, such as CSU and dental infection/inflammation of oral cavity and AF.We describe a 36-year-old man with an 8-year history of difficult-to-treat, uncontrolled CSU, co-existent with dental infection/inflammatory processes of oral cavity and permanent atrial fibrillation (AF). In the presented case, the most likely triggering or aggravating/maintaining factor of the symptoms was the inflammation/dental infection of the oral cavity because of rapid reduction of the urticarial symptoms, drug doses, and serum CRP levels after the dental therapy. Dental treatment may have a beneficial effect on the systemic inflammatory response, reducing/normalizing the circulating levels of APR markers. APR activation appears to worsen CSU course, early identification and treatment of infectious/inflammatory foci in the oral cavity would form the mainstay of supportive therapy for CU probably through reduction of the systemic inflammatory burden. APR associated with infectious/inflammatory foci in the oral cavity could be taken into account as a predisposing agents to AF.
authors.affiliation: Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia in Katowice, Poland alakasperska@gmail.com.
authors.forename: Alicja
authors.initials: A
authors.lastname: Kasperska-Zajac
authors.affiliation: Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia in Katowice, Poland.
authors.forename: Alicja
authors.initials: A
authors.lastname: Grzanka
authors.affiliation: Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kowalczyk
authors.affiliation: Department of Prosthetic Dentistry in Bytom, Medical University of Silesia, Katowice, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Wyszyńska-Chłap
authors.affiliation: Chair and Clinical Department of Otolaryngology in Zabrze, Medical University of Silesia, Katowice, Poland.
authors.forename: Grażyna
authors.initials: G
authors.lastname: Lisowska
authors.affiliation: Department of Prosthetic Dentistry in Bytom, Medical University of Silesia, Katowice, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kasperski
authors.affiliation: Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia in Katowice, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Jarząb
authors.affiliation: Chair and Clinical Department of Otolaryngology in Zabrze, Medical University of Silesia, Katowice, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Misiołek
authors.affiliation: Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
mesh_terms: D000210:Acute-Phase Reaction; D000328:Adult; D001281:Atrial Fibrillation / Q000209:etiology*; D002097:C-Reactive Protein / Q000032:analysis; D002908:Chronic Disease; D006801:Humans; D007239:Infections / Q000150:complications*; D008297:Male; D014076:Tooth Diseases / Q000150:complications*; D014581:Urticaria / Q000209:etiology*
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; acute phase response; atrial fibrillation; chronic spontaneous urticaria; dental infection; inflammation of oral cavity