Objectives:Wegener's granulomatosis (WG) is an uncommon multisystemic vasculitis characterized by a pathological triade, consisting of necrotizing granulomatous lesions of the respiratory tract, systemic vasculitis involving small arteries and veins, and necrotizing glomerulonephritis. We report a case of WG in a patient who initially presented with ulcerative gingivitis.
Materials and methods: A 59-year-old woman was referred to the Department of Oral Pathology and Medicine, School of Dental Sciences, University of Trieste, for an uncommon form of gingivitis with ulcerative and necrotic lesions. On the basis of the clinical, serologic, and histologic findings, the condition was provisionally diagnosed as an orofacial granulomatous condition. During follow-up, bilateral serous otitis media and acute ulceronecrotic rhinitis were also diagnosed by an otorhinolaryngologist. Systemic steroid therapy (prednisolone 25 mg for 10 days) was prescribed. It produced partial remission of the ear and nasal symptoms, as well as good improvement of the oral lesions.
Results: Considering the clinical, histological, laboratory, and instrumental findings (maxillofacial CT, chest radiography), the final diagnosis was WG.
Conclusions :Lesions involving the ear, nose, and oral cavity can be an early manifestation of WG. The mean survival of untreated patients is very low. Therefore, otorhinolaryngologists and dentists should both be aware of this condition as prompt referral and early diagnosis can be of crucial importance to the treatment outcome.
