Granulomatosis with polyangiitis (GPA) is a vasculitis syndrome related to antineutrophil cytoplasmic antibodies. Although reports suggest the disease is associated with mucosal ulcers, they are rarely found in the oral region. We report a case of GPA with large oral mucosal ulcers.
A 64-year-old man was referred to our clinic with the chief complaints of oral pain and an ulcer 40 × 30 mm in diameter extending from the right buccal mucosa to the alveolar ridge, oral floor and tongue. Contrast-enhanced computed tomography revealed a tumor lesion that was almost uniformly contrasted with the ulcer. Although a biopsy showed suspected malignant tumors, a diagnosis of GPA was obtained based on the presence of rupturing of small arteries and obstruction due to granulation tissue. As a result of consultation with our nephrology department, the lesion was found to be only in the oral mucosa, and the diagnosis was localized GPA. The patient was treated with high-dose steroid therapy, and the ulcer was cured in about one month. Low-dose steroid therapy is still ongoing to prevent systemic extension. After the disappearance of the ulcer, scaring contracted in the right corner of the mouth, buccal mucosa and tongue, causing dysfunction of the corner of the mouth and movement of the tongue. Therefore, plastic surgery of the right corner of the mouth and oral vestibular expansion were performed to improve oral function. There has been no recurrence of ulcers in the oral cavity three years after disappearance of the ulcer.
