Patrick Amy, Altman Keith
Oral Surgery, University College London Hospitals NHS Foundation Trust, London, UK.
Oral and Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK.
BMJ Case Rep. 2019 Apr 24;12(4):e229607. doi: 10.1136/bcr-2019-229607.
Gingival pathology is a daily presentation, however a small number of systemic conditions can manifest similar to a common gingival condition and have fatal results. Dentist referred 56-year-old woman to Oral and Maxillofacial Surgery department with a 2-week medical history of gingival bleeding not responding to local measures. Biopsy showed eosinophilic infiltrate and vasculitis, and blood tests showed positive markers including cytoplasmic antineutrophil cytoplasmatic antibodies. Granulomatosis with polyangiitis is a rare disease affecting the respiratory tract, blood vessels and kidneys. Oral lesions are rarely the primary presenting feature. When left untreated, most cases are fatal within a year of diagnosis. The diagnosis can only be made when certain criteria are found, including granular oral lesions exhibiting an eosinophilic inflammatory infiltrate on biopsy. With 5% of cases showing intraoral lesions as the primary feature, it is essential that dentists have the knowledge of this rare disease to refer and not to treat as a common gingival condition.
牙龈病变是日常常见的情况，然而少数全身性疾病可能表现得与常见的牙龈疾病相似，并会导致致命后果。一名56岁女性因牙龈出血两周且局部治疗无效，被牙医转诊至口腔颌面外科。活检显示嗜酸性粒细胞浸润和血管炎，血液检查显示包括抗中性粒细胞胞浆抗体在内的阳性指标。肉芽肿性多血管炎是一种罕见疾病，会影响呼吸道、血管和肾脏。口腔病变很少是主要的首发症状。若不治疗，大多数病例在诊断后一年内会死亡。只有在发现某些标准时才能做出诊断，包括活检显示颗粒状口腔病变伴有嗜酸性炎症浸润。由于5%的病例以口腔内病变为主要特征，牙医必须了解这种罕见疾病，以便进行转诊，而不是将其当作常见的牙龈疾病进行治疗。
