Int J Stomatol

Int J Stomatol ›› 2019, Vol. 46 ›› Issue (4): 426-430.doi: 10.7518/gjkq.2019051

• Case Report • Previous Articles     Next Articles

Seronegative granulomatosis with polyangiitis: a case report and literature review

Chen Hong,Wu Lanyan,Zheng Guangning,Lin Mei()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2018-06-28 Revised:2019-04-10 Online:2019-07-01 Published:2019-07-12

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Abstract:

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis and necrotising glomerulonephritis. The clinical manifestations of this condition are complex and varied, and the diagnosis requires the combined results of clinical symptoms, anti-neutrophil cytoplasmic antibody (ANCA) detection and histopathological examination. Strawberry gingivitis of GPA is rarely the reason of initial clinical presentation that is similar to inflammatory and infective diseases. This paper reports the case of a 50-year-old Chinese Tibetan patient with diagnostically difficult, ANCA-negative GPA that initially presented with oral and nasal manifestations only. The aim of this study is to remind dentists the possibility of GPA when faced with similar clinical manifestations. Moreover, early diagnosis and treatment play an important role in the improvement and prognosis of patients with GPA.

Key words: granulomatosis with polyangiitis, case report, literature review, anti-neutrophil cytoplasmic antibody

CLC Number: 

  • R781.5+9

TrendMD: 

Fig 1

Intraoral photograph at the initial, second consultation and followed for three years"

Tab 1

The results of laboratory test"

项目 结果 参考值 项目 结果 参考值
白细胞计数/（×109 L-1） 10.34 3.5~9.5 抗双链DNA抗体 阴性
红细胞计数/ （×1012 L-1） 4.12 4.3~5.8 乙肝表面抗原/COI 1 867.000 -
血红蛋白/（g·L-1） 149 130~175 乙肝表面抗体/COI 阴性
血小板计数/（×109 L-1） 362 100~300 乙肝e抗原/COI 0.074 0~1
抗核抗体 阳性 阴性 乙肝e抗体/COI 0.004 ﹥1.00
CD3细胞亚群/ % 60.80 66.9~83.1 乙肝核心抗体/COI 0.005 ﹥1.00
CD4细胞亚群/ % 28.30 33.19~47.85 丙肝抗体/COI 阴性（0.033） ﹥1.00
CD8细胞亚群/ % 30.7 20.4~34.7 梅毒抗体 阴性（0.000） 0~1
CD4/CD8比值 0.92 0.97~2.31 梅毒特异性抗体/（s/co） 阴性（0.765）
CD4绝对计数/μL-1 448 471~1 220 人类免疫缺陷病毒抗体/（s/co） 阴性（0.069）
CD3绝对计数/μL-1 964 941~2 226 抗中性粒细胞浆抗体 阴性
CD8绝对计数 /μL-1 486 303~1 003 蛋白酶3 ﹤1.0 阴性
免疫球蛋白G 16.3 7~16.6 乳铁蛋白 ﹤1.0 ﹤1.0
补体C4 0.39 0.1~0.4 髓过氧化物酶 ﹤1.0 ﹤1.0
补体B因子 505 190~500 弹性蛋白酶 ﹤1.0 ﹤1.0
肾小球滤过率 阴性 组织蛋白酶 ﹤1.0 ﹤1.0
C-反应蛋白 阴性 杀菌性膜通透性蛋白 ﹤1.0 ﹤1.0

Fig 2

X-ray, CBCT and nasal CT of the patient"

Fig 3

Photomicrograph of the gingivae Hematoxylin-eosin staining"

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