Refractory Pseudomembranous Lesions on the Gums of a Young Patient with Plasminogen Deficiency

Abstract

Plasminogen deficiency is classified as type I and type II. Patients with type II generally show no clinical symptoms, whereas in type I cases, fibrin does not become degraded during wound healing, resulting in the development of ligneous pseudomembranous areas on mucous membranes. The most common clinical manifestation seen in type I is ligneous conjunctivitis, which causes the formation of recurrent pseudomembranous lesions on the conjunctiva. In addition, these lesions may also form on areas in the middle ear, oral mucosa, pharynx, duodenum, respiratory tract, and female genitalia, leading to congenital obstructive hydrocephalus. There are few reports on patients with pseudomembranous formed on the oral mucosa. We report a case in which pseudomembranous periodontal lesions were observed in the oral cavity of a patient with plasminogen deficiency. The type is unknown, though probably type I based on the symptoms.

The patient was a 4-year-old girl in Japan who had Dandy-Walker syndrome, hydrocephalus, epilepsy, and intellectual disability. Plasminogen deficiency was also noted, with ligneous conjunctivitis and gingival pseudomembranous observed as symptoms. Ointment application, antibiotic administration, and washing were performed, as well as Er：YAG laser irradiation to pseudomembranous areas of the gingiva. As a result, some of those areas showed some shrinkage, but they did not completely disappear. It is considered highly likely that pseudomembranous regions will form and expand if oral hygiene deteriorates, making it necessary to continue providing oral care.