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首页> 外文期刊>Journal of Medical Case Reports >Granulomatosis with polyangiitis (Wegener’s) as a necrotizing gingivitis mimic: a case report
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Granulomatosis with polyangiitis (Wegener’s) as a necrotizing gingivitis mimic: a case report

机译：肉芽肿伴多血管炎（韦格纳氏病）作为一种坏死性牙龈炎的模仿：一例报告

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Introduction Granulomatosis with polyangiitis poses a significant diagnostic dilemma due its diverse presentations. Seemly isolated sites of disease, such as oral ulcers, may present to physicians working in primary care settings, the emergency room, and subspecialty fields as well as to dentists. Oral presentations are particularly challenging to identify and require a high index of suspicion and a detailed knowledge of the condition in order to diagnose and treat. We detail a case of granulomatosis with polyangiitis presenting as necrotizing gingivitis, one of the first of its kind to be reported. Case presentation An otherwise healthy 32-year-old, Caucasian woman presented to various physicians with progressive, painful oral ulcers. Following consultations with multiple primary care physicians and subspecialties, an initial diagnosis of severe infectious necrotizing gingivitis was made resulting in combination antibiotic treatment as well as surgical debridement involving extraction of all maxillary and three mandibular teeth. With the discovery of a positive cytoplasmic anti-neutrophil cytoplasmic antibody and a constellation of associated systemic symptoms, our patient was subsequently diagnosed with granulomatosis with polyangiitis. The treatment regimen of rituximab and methylprednisone was chosen in consideration of our patient’s desire for future fertility and has been successful in inducing and maintaining remission. Conclusions Following the case presentation, we review the current literature regarding granulomatosis with polyangiitis presentation, diagnosis and treatment. In discussing features of granulomatosis with polyangiitis presentation, diagnostic tests, and important new treatment options, we seek to enable physicians of all specialties to better recognize and begin appropriate treatment for this complex condition.
机译：引言肉芽肿合并多血管炎由于其多样的表现而引起重大的诊断难题。看似孤立的疾病部位（例如口腔溃疡）可能会出现在基层医疗机构，急诊室和亚专业领域的医生以及牙医那里。进行口头报告对于识别并要求高度怀疑和对病情的详细了解才能进行诊断和治疗特别具有挑战性。我们详细介绍了肉芽肿伴多发性血管炎表现为坏死性牙龈炎的病例，这是有史以来首例此类病例之一。病例介绍一位健康状况良好的32岁白人妇女因各种进行性，痛苦的口腔溃疡向医生介绍。经过与多家初级保健医生和亚专业的磋商，初步诊断出严重的感染性坏死性牙龈炎，导致联合抗生素治疗以及包括清除所有上颌和三颗下颌牙在内的外科清创术。随着发现一种阳性的胞浆抗中性粒细胞胞浆抗体和一系列相关的全身症状，我们的患者随后被诊断为肉芽肿伴多血管炎。选择利妥昔单抗和甲基强的松治疗方案是考虑到我们患者对未来生育的渴望，并已成功诱导和维持了缓解。结论在病例介绍之后，我们回顾了有关肉芽肿合并多血管炎的表现，诊断和治疗的文献。在讨论肉芽肿病的多血管炎表现，诊断测试和重要的新治疗方法时，我们力求使所有专业的医生都能更好地认识并开始针对这种复杂疾病进行适当治疗。

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