Navigating the complexities of diagnosing and treating oral Langerhans Cell Histiocytosis in a third world country – a case report

Langerhans Cell Histiocytosis is a rare disease of an unknown etiology, with the incidence of 0.7 per million annually. The oral lesions in this disease may be the initial sign of an undiagnosed systemic or localized LCH, or even indicate a recurrence in already diagnosed patients. Clinically, it can be misdiagnosed as primary oral inflammatory, infectious, or even neoplastic lesions. Early diagnosis and management may mitigate the advancement of the pathological process, which if left untreated could ultimately culminate in the total loss of teeth, consequently hindering the ability to provide prosthetic rehabilitation and dentition replacement. The most typical findings in oral Langerhans’ cell histiocytosis are pain, swelling, tooth loss/mobility, and bone lesions. Periodontally, it manifests as gingival ulcerations, increased pocket depths, and gingival bleeding. Herein we present a case of a 27-year-old male who presented with a history of painful, bleeding gums, halitosis. and a clinical picture mimicking severe periodontal disease - marked by diffuse gingival erythema, edema, spontaneous bleeding and root exposure. These clinical features were seen in an otherwise young adult with no risk factors - the atypical presentation warranted further investigation, ultimately revealing an underlying diagnosis of Langerhans Cell Histiocytosis.