A case of granulomatosis with polyangiitis accompanied with strawberry gingivitis, and a review of the literatures

Abstract

Hyperplastic granular gingivitis, also known as “strawberry gingivitis” (SG), is a characteristic oral presentation of granulomatosis with polyangiitis (GPA). We report a case of a 38-year-old woman who complained of swollen gums, which had an over-ripe strawberry appearance. Examination revealed pulmonary involvement and a positive finding for proteinase 3 anti-neutrophil cytoplasmic (PR3-ANCA) antibody. A gingival biopsy showed granulomatous infiltration, neovascularisation, inflammatory cell infiltration and pseudoepitheliomatous hyperplasia. These clinical features suggested a diagnosis of GPA. A moderate dose of systemic corticosteroids and methotrexate was effective. To confirm her diagnosis, we conducted a literature review of SG accompanied with GPA. The physical and pathological presentations of SG were typical for GPA. Most cases were positive for PR3-ANCA. Some showed pathological proof of vasculitis with granulomatous formations, suggesting that SG is a typical feature of GPA. Most reviewed cases were classified as being localised or at the early systemic stage, and required less intensive treatment and resulted in a favourable outcome. The findings suggest that SG is an early manifestation of GPA, and GPA should be considered for patients who present with swollen gums.

Keywords:

• Granulomatosis with polyangiitis
• swollen gums
• strawberry gingivitis
• proteinase 3 anti-neutrophil cytoplasmic antibody
• vasculitis

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Patient consent

A written informed consent for this case report has been obtained from the patient.

Conflict of interest

None.