Abstract
A case of Wegener's granulomatosis which is first manifested itself as a granulomatous lesion of the gingiva is reported. Wegener's granulomatosis is characterized by a necrotic and granulomatous changes of the upper or lower respiratory tract, glomerulonephritis and disseminated small vessel vasculitis. This disease is defined as a auto-immunity disease recently.
Fourty three-year-old man was referred to the Nippon Dental University hospital with and unusual form of severe gingivitis and mastication problem. In the initial examination, severe swelling and flare of whole gingiva were observed. Those surfaces had granular or strawberry like structure (granular gingivitis). Severe alveolar bone resorption, periodontal pocket formations more than 7mm and severe tooth mobility were observed. The patient had intermittent pain in gingivitis region. In the laboratory findings, positive CRP and RA, slight increasing of PMNs number and decreasing of lymphocytes number were observed.
Two weeks later, severe swelling of right palpebra dacryohemorrhea, ulceration on the left temporal region and notal skin region were observed. Especially, the rhinorrhea with blood like secretion was also observed. The granulomatous lesion of the gingiva was changed to the ulcerative gingiva and could be observed a bone surface denudation. Deciduation of many teeth were occurred and residual teeth showed high mobility. In the lymphocyte subset analysis, T cell ratio in peripheral blood was decreased, B cell ratio was increased, NK cell ratio was extremely increased and the helper T cell/suppressor T cell ratio (H/S) was 1.8.
Four days later, this patient was ended in death due to the rapid fulminating downhill course in systemiccondition. This disease was diagnosed as Wegener's granulomatosis from results of autopsy.
The specific features of this case are following findings.
1. Granular gingivitis was an initial symptom instead of necrotic and granulomatous changes of the nasopharynx, 2. Acute necrotic changes of gingiva and oral mucosa, 3. The increasing of tooth mobility and the falling of teeth accompanying the progression of oral lesion, 4. Acute and fulminant granulomatouschanges of constitutional organs, 5. Decreasing of T cell ratio and increasing of B cell ratio in whole neutrophils, 6. Increasing of NK cell ration in whole neutrophils.
Above findings suggest that presence of putative periodontal pathogens is connected with the initiation of Wegener's granulomatosis.
