State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China.
National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China.
BMC Oral Health. 2021 May 28;21(1):279. doi: 10.1186/s12903-021-01592-2.
Immunoglobulin G4-related disease (IgG4-RD) is a chronic inflammatory systemic disease of unknown etiology that can affect one or multiple organs. The disease can mimic many infectious and inflammatory diseases, mainly causing organ enlargement or hyperplasia. Its diagnosis primarily relies on clinical, serologic, and histological features (lymphoplasmacytic infiltrates, storiform fibrosis, and obliterative phlebitis of IgG4 + plasma cells). Here, we report a rare case of IgG4-related periodontitis, and review the relevant literatures.
A 38-year-old Chinese man visited the Department of Periodontics with gingival enlargement, loose teeth, and tooth loss. The patient had very poor oral hygiene and a large amount of calculus. Gingivae were edematous with deep periodontal pockets and attachment loss. Panoramic radiography showed alveolar bone loss. Serologic examination showed that IgG was 23.70 g/L and IgG4 concentration was 2.800 g/L. There was significant lymphoplasmacytic infiltration, a storiform pattern of fibrosis, and mitotic figures with hematoxylin and eosin staining; immunohistochemical staining showed 10 scattered IgG4-positive plasma cells in a high-power field. The patient was diagnosed as IgG4-related periodontitis. He received a course of corticosteroids with periodontal therapy, and the enlargement was significantly improved without recurrence.
IgG4-RD in the oral and maxillofacial region mainly involves salivary glands, but this rare case was characterized by enlarged gingivae. The differential diagnosis of IgG4-RD should be based on the clinical features and serologic (IgG4) and histopathological examinations. Corticosteroid therapy is effective for most IgG4-RD patients. Taken together, we hope this case report and the literature review can help dentists to improve their understanding of the IgG4-RD.
免疫球蛋白 G4 相关疾病（IgG4-RD）是一种病因不明的慢性炎症性全身性疾病，可影响一个或多个器官。该疾病可模仿许多感染性和炎症性疾病，主要导致器官肿大或增生。其诊断主要依赖于临床、血清学和组织学特征（淋巴浆细胞浸润、席纹状纤维化和 IgG4+浆细胞闭塞性静脉炎）。在此，我们报告一例罕见的 IgG4 相关牙周炎病例，并复习相关文献。
一名 38 岁的中国男性因牙龈肿大、牙齿松动和牙齿缺失就诊于牙周科。患者口腔卫生极差，有大量牙石。牙龈肿胀，牙周袋深，附着丧失。全景片显示牙槽骨吸收。血清学检查显示 IgG 为 23.70 g/L，IgG4 浓度为 2.800 g/L。组织学检查可见显著的淋巴浆细胞浸润、席纹状纤维化模式和有丝分裂象，苏木精-伊红染色；免疫组化染色显示高倍镜下有 10 个散在 IgG4 阳性浆细胞。患者被诊断为 IgG4 相关牙周炎。他接受了皮质类固醇治疗和牙周治疗，牙龈肿大明显改善，无复发。
口腔颌面部 IgG4-RD 主要累及唾液腺，但本例以牙龈肿大为特征。IgG4-RD 的鉴别诊断应基于临床特征和血清学（IgG4）和组织病理学检查。大多数 IgG4-RD 患者对皮质类固醇治疗有效。综上所述，我们希望本病例报告和文献复习能帮助牙医提高对 IgG4-RD 的认识。
