Granulomatous disease Flashcards
What are granulomas?
Collection of macrophages due to the inflammatory process
What are idiopathic, non-infectious granulomatous disorders of the OC associated with histologically?
Non-ceasating epithelioid granulomas and multinucleated Langerhans type giant cells
What type of granulomas are typically associated with infectious granulmatous lesions
Caesating granulomas
What is tuberculosis
Chronic bacterial infection caused by mycobacterium tuberculosis
Symptoms of tuberculosis
Malaise, anorexia, weight loss, fever,night sweats, cough with purulent or blood strained sputum
Compare primary and secondary oral tuberculosis
Primary oral TB occurs alone, very rare and usually in children, often asymptomatic
Secondary oral TB is more common (2nd to pulmonary) and seen in elderly pts, often painful
Describe oral tb lesions
- Location - tongue, gingiva, FOM, hard palate
- May present as an ulcer with indurated edges (Appears malignant) which replicates (chronic ulcerations)
- Additional - parotid gland involvement, lesions on bone, cervical/submental/submandibular lymphadenopathy
IX of tuberculosis
Blood tests are quicker and more accurate
Biopsy to show mycobacterium or infectious granulomatous infiltrate
Tx of tuberculosis
- 3/4 antibiotics for 2 months - isoniazid, rimfapicin, pyrazinamide and ethambutol
- 4 months - isoniazid and rimfapicin
What is granulomatosis with polyangiitis?
Rare, multisystem chronic granulomatous disease chracterised by granulomatous lesions of the respiratory tract, systemic vasculitis of small arteries and veins and necrotising glomerulonephritis
Describe the systems affected by granulomatosis with polyangiitis
- Lungs - pulmonary nodules, infiltrates, cavities, haemoptysis
- Kidney - necrotising glomerulonephritis, CKD
- Joints - arthritis, arthralgia or swelling
- ENT issue - rhinitis, hearing loss, conjunctivitis
- Cutaneous - nodules and purpura
- Nervous system - sensory neuropathy, facial nerve palsy
Describe the oral lesions associated with granulomatosis with polyangiitis
- Oral ulcerations on the tongue, BM, gingiva or palate
- Strawberry gingiva
- Tooth mobility and exfoliation
- Poor post op xla healing
- Cranial nerve palsy
- Parotid gland swelling
- Palatal swelling
Describe the ulcerations in granulomatosis with polyangiits
- Ulcer-like apthae or diffuse ulcerative stomatitis
What is strawberry gingiva?
Type of gingival hyperplasia where the gingiva looks like strawberry skin
Ix and diagnosis of granulomatosis with polyangiitis
Biopsies showing granulomatosis infiltrate
CXR showing nodules, fixed infiltrates or cavities
Urine showing RBC
Nasal discharge or oral swellings
Tx of granulomatosis with polyangiitis
Initial - cyclophosphamide and prednisolone +/- methotrexate, ritixumab or mycophenolate
Maintainence - methotrexate or azathioprine alongisde prednisolone
Relapse - cyclophosphamide or rituximab with increased prednisolone dose
What is oro-facial granulomatosis?
Condition characterised by granulomatous enlargement of the area around the mouth and jaws, in the absence of a recognised systemi condition causing granulomas
What is the aetiology of OFG?
Unknown - possibly genetics, microbiome, hypersensitivity, many have atopic background (asthma, hayfever, eczema)
Presentation of oro-facial granulomatosis
- Lip enlargement (upper lip, may be unilateral, redness, angular chelitis or lip fissuring due to dryness)
- Intraoral swelling - BM may be thick and lumpy with reduced mouth opening
- Mucosal tags
- Oral ulcerations
- Atypical gingivitis
Describe the gingival lesions in oro-facial granulomatosis
- Extends from the free gingival margins to the full depth of the sulcus
- Red or orange (orange peel)
- Maxilla > mandible
- Poor OH, burning and profuse bleeding
Ix of oro-facial granulomatosis
- Biopsy (full thickness gingiva OR areas adjacent to ulcerations)
- Clinical activity score - site, activity, type of lesion
Link between OFG and crohn’s
Controversial if OFG is its own disorder or just a manifestation of crohns - increased risk of those with OFG developing crohns in their lifetime
What is Crohn’s disease
Chronic, inflammatory bowel disease (IBD) that may affect any area of the gastrointestinal tract from the mouth to the anus
List the oral manifestations of Crohn’s disease
Aphthous ulcers (linear ulcers in the sulcus are diagnostic) Cobblestoning of the buccal mucosa Fibrous banding scarring Mucosal tags Erythema Xerostomia Gingivitis/mucogingivitis Inflammation and or abscess in salivary ducts
Tx of crohns disease
- Dietarty restrictions
- topical lesions for ulcerations
- intralesional corticosteroids
- DRUGS - immunosuppressants (prednisolone, azathioprine, methotrexate and infliximab) and immunomodulatory (anti-TNFalpha 2,3)
