CR0324 Unusual case of granulomatosis with polyangiitis (Wegener granulomatosis)

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<ul><li><p>ORAL MEDICINE OOOO</p><p>e388 Abstracts May 2014differentiate among neoplasm, sialosis, tuberculosis, actinomy-cosis, orofacial granulomatosis, and systemic disorders affectingsalivary glands, such as Sjgren syndrome, IgG4-related disease,and sarcoidosis. In the differential diagnosis, it is important toinclude a thorough medical history, physical examinations,radiologic and serologic tests, and pathologic examinations.</p><p>CR0299 HERPES ZOSTER VIRUSeASSOCIATED ERY-THEMA MULTIFORME IN A CHILD E.A. Hullah,P. Thakrar, R.J. Cook, Kings College London Dental Insti-tute, Guys and St Thomas Hospital, London, United Kingdom</p><p>Background: Erythema multiforme (EM) is a mucocuta-neous condition, rarely associated with varicella zoster virus(VZV) infection in children, despite the viruss high incidence asa childhood pathogen. In the literature, only 2 cases of VZVassociated with EM have been recorded, one in a 5-year-old andthe other in a 13-year-old. One case of VZV associated withStevens-Johnson syndrome in a 12-month-old has also been re-ported to date.</p><p>Summary: A 10-year-old girl presented with a 2-yearhistory of recurrent severe oral EM episodes, requiring multi-ple hospital admissions for lethargy, diet, and uid support. Oneach admission, the condition responded to systemic cortico-steroids but proved recalcitrant to subsequent prophylacticacyclovir, such that she had eventually been maintained onlow-dose prednisolone alone. Direct questioning found that shehad had a severe primary VZV infection at age 2, which hadnecessitated admission to a high-dependency unit. She wasotherwise t and healthy, and all herpes simplex virus serologywas negative at presentation to our unit. There was no evidenceof mycoplasma pneumonia infection or other common triggersin the history. The prophylactic use of systemic valacyclovir500 mg twice daily proved effective in preventing further acuteepisodes and facilitated total withdrawal of all systemic corti-costeroid therapy. Fatigue and somnolence have resolved, andnormal energy levels have returned, along with return to full-time education participation.</p><p>Conclusions: VZV-associated EM is a rare condition.However, VZV must be considered as a possible trigger forEM-type eruptions. Failure of previous prophylactic acyclovirtreatment may be due to not achieving sufcient tissue concen-tration of acyclovir. Systemic use of valacyclovir in patientswith recurrent EM (or herpes simplex virus infection) can providebetter therapeutic results and lowers the risk of selecting acyclovir-resistant VZV strains.</p><p>CR0324 UNUSUAL CASE OF GRANULOMATOSISWITH POLYANGIITIS (WEGENER GRANULOMATOSIS)Rui Albuquerque, Gareth Elias, Andrea Richards, D.M.Carruthers, School of Dentistry, University of Birmingham,Birmingham, United Kingdom</p><p>Background: Granulomatosis with polyangiitis (GPA) is arare multisystem disease associated with small-vessel vasculitis ofunknown etiology. Diagnosis is through clinical and laboratoryndings, of which the main marker is circulating antineutrophilcytoplasmic antibodies (cANCA) with antieproteinase 3 (PR3)specicity. Characterization of common clinicopathologic fea-tures of disease activity in patients with vasculitis aids earlydiagnosis.</p><p>Summary: A 57-year-old woman presented in 2005 to theneurology service with sudden-onset progressive sensorineuralhearing loss. She was found to be cANCA positive. A diagnosisof GPA was subsequently conrmed. She was treated initiallywith cyclophosphamide and subsequently with methotrexate. In2007 she developed a dry cough, and a chest radiograph foundcavitating pulmonary lesions. Cyclophosphamide was recom-menced in combination with oral prednisolone, and later azathi-oprine was added. Two years later, her disease reactivated with acrusting nose and other symptoms, for which she was treated withmethotrexate and leunomide. This resulted in stabilization of herdisease, and serology was subsequently cANCA negative. Shewas then maintained on low-dose immunosuppressive therapy.In 2013, she presented to the Oral Medicine department com-plaining of localized red, boggy, and bleeding gingival swellings.Examination found the typical strawberry gingivae appearanceconsistent with a diagnosis of GPA. This was her rst oralmanifestation of the disease.</p><p>Conclusions: Well-known oral manifestations of activeGPA, such as oral ulceration or strawberry gingivitis, are oftenseen at initial presentation. However, our patient had experi-enced many episodes of disease activity accompanied bypositive serologic markers in the absence of any oralinvolvement. Her recent presentation with oral manifestationstypical of GPA, but without other clinical or serologic evidenceof her diagnosis, emphasizes the need for awareness of thesignicance of the clinical appearances. Close monitoring forearly detection of any recurrence of her systemic disease isindicated.</p><p>CR0325 INCIDENTAL FINDINGOF BISPHOSPHONATE-RELATED OSTEONECROSIS OF THE JAWS AFTER SELF-EXTRACTION Temitope Omolehinwa, Arthur Kuperstein,Department of Oral Medicine, School of Dental Medicine,University of Pennsylvania, Philadelphia, PA, USA</p><p>Background: The bisphosphonate class of drugs is awidely used, effective class of medication used in the treatmentof skeletal complications and hypercalcemia of malignancies,such as multiple myeloma and metastatic solid tumors.However, bisphosphonate-related osteonecrosis of the jaws(BRONJ) is not an uncommon reported complication of thistherapy.</p><p>Summary: A 59-year-old black man presented for extrac-tion of all his teeth as a result of multiple odontogenic abscessesand advanced periodontal disease. In addition, a complaint ofsharp tooth build-up cutting into his tongue was made. Hismedical history was positive for type 2 diabetes, hypertension,hyperlipidemia, chronic kidney disease, and hepatitis C. Onintraoral examination, the patient was partially dentate, withgeneralized gingival recession and grade 2 to 3 mobility of all hispresent teeth. Also noted in the lower right posterior quadrantwas an area of hard exophytic mass, with surrounding gingivalinammation. Periapical radiographs found a bony sequestrum atthe alveolar crest in the area of the mandibular right rst premolarthrough the mandibular right second molar. The patient wasquestioned on history of bisphosphonate use, which he denied.After gentle interrogation, the patient reported self-extracting amobile tooth in the area where the exophytic mass was noted,about a year before presentation. His medical records included apositive history of multiple myeloma with ongoing dexametha-sone (Decadron) and bortezomib (Velcade) therapy. In addition,the patient had previously taken zoledronic acid. Cone beamcomputed tomography and panoramic radiographs found multiple</p><p>CR0299 Herpes zoster virusassociated erythema multiforme in a childBackgroundSummaryConclusions</p><p>CR0324 Unusual case of granulomatosis with polyangiitis (Wegener granulomatosis)BackgroundSummaryConclusions</p><p>CR0325 Incidental finding of bisphosphonate-related osteonecrosis of the jaws after self-extractionBackgroundSummary</p></li></ul>


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