Rheumatology 2018;0:1 Clinical vignette doi:10.1093/rheumatology/key078 Strawberry gingivitis in granulomatosis with ulcerative skin lesion on the left flank and hearing loss polyangiitis due to serous otitis media. Laboratory evaluation revealed elevated acute phase reactants together with positive im- A 22-year-old man complained of persistent gingival munofluorescence for c-ANCA and enzyme immunoassay hyperplasia and bleeding with rhinitis. Physical examin- for anti-PR3 antibodies. A CT scan of the chest showed ation showed hyperplastic gingivitis with red purple some nodules. The diagnosis of granulomatosis with poly- oedematous interdental papillae diffusely covered angiitis was made and the patient was given a high dose with petechiae. The lesion displayed the typical of corticosteroids and monthly i.v. CYC. A complete re- pebbly appearance of strawberry gingivitis (Fig. 1A). mission was observed after 6 months when CYC was Histopatological examination of the gingival tissue ob- replaced by AZA. Clinicians should keep in mind that tained by biopsy showed a granulomatous inflammation strawberry gingivitis may be the initial manifestation of containing lymphocytes, plasma cells, histiocytes and granulomatosis with polyangiitis. multinucleated giant cells together with haemorrhagic areas and numerous neutrophilic debris coalescing Acknowledgements in microabscesses (Fig. 1B, haematoxylin and eosin stained). Similar features were observed in a nasal speci- Thanks go to Professor Ignazio Olivieri for having con- men. In the following weeks the patient developed an veyed to us the importance of honesty and humility. Funding: There was no financial support. Disclosure statement: All authors have declared no FIG 1 Hyperplastic gingivitis with red purple edematous conflicts of interest. interdental papillae diffusely covered with petechiae. (A) Lymphocytes, plasma cells, histiocytes and multinucleated 1 2 Pietro Leccese , Carlo Palazzi , giant cells together with haemorrhagic areas and numerous 1 1 Salvatore D’Angelo and Angela Anna Padula neutrophilic debris coalescing in microabscesses ( 10) (B) Rheumatology Institute of Lucania (IReL) and the Rheumatology Department of Lucania, San Carlo Hospital, Potenza and Rheumatology Institute of Lucania (IReL) and the Rheumatology Department of Lucania, Madonna delle Grazie Hospital, Matera, Italy Correspondence to: Pietro Leccese, Via Potito Petrone, 1, Potenza, 85100, Italy. E-mail: email@example.com ! The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: firstname.lastname@example.org Downloaded from https://academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/key078/4948681 by Ed 'DeepDyve' Gillespie user on 08 June 2018
Rheumatology – Oxford University Press
Published: Mar 21, 2018
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