Strawberry gingivitis as the initial manifestation of granulomatosis with polyangiitis in a patient with alpha-1 antitrypsin deficiency

Strawberry gingivitis, albeit uncommon, is a pathognomonic oral manifestation of granulomatosis with polyangiitis (GPA) and may be the first clinical indication in the absence of systemic signs.Prompt recognition and biopsy of atypical oral lesions can aid in the early detection of GPA and avert potentially deadly consequences.Alpha-1 antitrypsin deficiency, which is frequently ignored, may contribute to GPA development and should be evaluated during the diagnostic workup, especially in patients with a family history or pulmonary susceptibility.