Burgeoning Painful Gingival Swelling Of Granulomatosis With Polyangiitis

Granulomatosis with polyangiitis (GPA) is a rare noninfectious small-to-medium vessel vasculitis that could affect oral cavity, characterized by strawberry-like gingivitis. A 32-year-old man complaint of swollen gums in the left molar area. He was treated as chronic periodontitis with simple ultrasonic scaling and minocycline hydrochloride ointment for a week. However, the patient was progressively exacerbated in the following 6 weeks. According to the biopsy and lab results, the final diagnosis was GPA. The patient was treated with prednisolone for 15 weeks, getting great remission on gingiva. However, as the presence of extra-oral symptom, the patient received higher dose of glucocorticoid. As all of the patient’s symptoms disappeared, he gradually tapering medicine. At last follow-up of 1 year after treatment, he has been in remission and hasn’t had a relapse yet. Strawberry-like gingivitis could be the initial sign of GPA, a life-threatening rare disease. Thus, swift recognizing specific oral sigh of GPA via dental pracititioner is important to early diagnosis and treatment. Atypical pathological result shouldn’t rule out diagnosis of GPA, otherwise, the missed diagnosis is extremely dangerous. For it is fatal if untreated. Also ANCA level should be monitored, for it is related with disease severity, impacting on adjusting the medication. GPA is a life-threatening rare disease, and the gingiva lesion could be the initial sign. Thus, swift recognizing specific oral sigh of GPA via dental practitioners is important to early diagnosis and treatment.