Strawberry gingivitis as the first sign of wegener’s granulomatosis: a case report

Abstract

Objective: To describe that Wegener’s granulomatosis (WG) is an autoim­mune multisystem disease with unknown etiolo­gy, characterized by the classic triad of necrotizing granulomas affecting the upper and lower respiratory tracts, disseminated vasculitis and glomerulonephritis. WG can affect any organ including kidneys, eyes or other organs. Oral involvement, like strawberry gingivitis, is an important sign of this disease even though it is rare.Methods: A 19 years old female was referred to oral medicine clinic with the chief complaint swelling on the gingiva which was increasing widespread. Since one month before the gingival enlargement did not respond to antibiotic.  Intraoral examination, showed gingival enlargement at the upper anterior, palate, and first left mandibular molar. The swollen tissue was characterized by its granularity, short bulbous projections and bright red colour. The gingival appearance mimicking an overripe strawberry and extra oral examination showed cutaneous vasculitis at the hands and feet.  Laboratory evaluation presented erythrocyte sedimentation rate, CRP and eGFR (modified MORD) were elevated but the urinalysis was within normal ranges. Based on the anamnesis, clinical and laboratory examination, WG diagnosis was made. The patient was treated with oral corticosteroids and chlorhexidine gluconate 0.1% mouthwash.Results: The gingival inflammation improved after one month therapy and the patient still being followed-up at reguler time. Conclusions: Early detection of oral manifestation of WG is important for dentists, especially oral medicine specialist, in order to achieve adequate treatment and preventing systemic tissue or organ damage.