10.5826/dpc.1303a171
text/xml
2160-9381
3138
en
Rahul  Mahajan
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Strawberry Gingivitis - A Diagnostic Clue in a Male With Epistaxis and Hemoptysis
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-07-31
2023-01-08
2023-07-31
2023-08-24
e2023171
Dermatol Pract Concept
Rahul  Mahajan
2023/07/31
10.5826/dpc.1303a171
e2023171
Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2160-9381
en
e2023171
Siar CH, Yeo KB, Nakano K, Nagatsuka H, Tsujigiwa H, Tomida M, et al. Strawberry gingivitis as the first presenting sign of Wegener's granulomatosis: report of a case. European journal of medical research. 2011;16:331-4.
Strawberry Gingivitis - A Diagnostic Clue in a Male With Epistaxis and Hemoptysis
https://dpcj.org/index.php/dpc/article/download/3138/2245
           Strawberry Gingivitis - A Diagnostic Clue in
              a Male With Epistaxis and Hemoptysis
                        Adhyatm Bhandari1, Sheetanshu Kumar1, Anuradha Bishnoi1,
                         Rajsmita Bhattacharjee1, Aman Sharma2, Rahul Mahajan1


1 Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Rheumatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India



Citation: Bhandari A, Kumar S, Bishnoi A, Bhattacharjee R, Sharma A, Mahajan R. Strawberry Gingivitis - A Diagnostic Clue in a Male
with Epistaxis and Hemoptysis. Dermatol Pract Concept. 2023;13(3):e2023171. DOI: https://doi.org/10.5826/dpc.1303a171
Accepted: February 2, 2023; Published: July 2023
Copyright: ©2023 Bhandari et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Dr Rahul Mahajan, Associate Professor, Department of Dermatology, Venereology, and Leprology, Postgraduate
Institute of Medical Education and Research, Chandigarh, India. Phone no: 91-172-2756564 E-mail: drrahulpgi@yahoo.com




Case Presentation                                                        and the patient was started on oral corticosteroids and
                                                                         immunosuppressants.
A young male presented with the complaint of gingival
swelling which started 15 days before and increased rap-
                                                                         Teaching Point
idly in size. He gave a history of productive cough with
bouts of streaky hemoptysis for the past 9 months along                  WG is characterized by necrotizing and granulomatous vas-
with episodes of rhinitis, nasal crusting and nasal bleeding             culitis predominantly affecting the respiratory tract and kid-
for the past 1 month. On mucocutaneous examination, en-                  neys but may also involve other tissues [1]. Oral involvement
largement of maxillary gingiva and lower labial mucosa                   in WG is observed in 6%-13% of patients and oral cavity
was observed with granular surface and overlying petechial               may be the first site of involvement in 5%–6% of cases [1].
spots giving an appearance of a “ripe strawberry”. Inves-                Strawberry gingivitis is considered to be a characteristic
tigations revealed ground glass opacities in the lungs on                sign of WG and presents as red to purple enlarged gingiva
contrast-enhanced computed tomography (CECT) chest,                      with petechiae and granular surface resembling an over-ripe
maxillary sinusitis on non-contrast computed tomogra-                    strawberry. Other differentials for similar gingival enlarge-
phy scan of the paranasal sinuses (NCCT PNS) and posi-                   ment include drug-induced gingival hypertrophy, hemangi-
tive cytoplasmic antineutrophil cytoplasmic autoantibody                 omas, pyogenic granulomas, Crohn’s disease , sarcoidosis,
(C-ANCA) serology. On the basis of above findings, a di-                 peripheral giant cell granuloma and Kaposi sarcoma [2].
agnosis of Wegener granulomatosis (WG) was established                   Presence of characteristic strawberry gingivitis is a vital clue




Image Letter | Dermatol Pract Concept. 2023;13(3):e2023171                                                                             1
                                                                    in the patients of WG who otherwise lack several other typ-
                                                                    ical features.


                                                                    References
                                                                     1. Almouhawis HA, Leao JC, Fedele S, Porter SR. Wegener's granu-
                                                                        lomatosis: a review of clinical features and an update in diagno-
                                                                        sis and treatment. J Oral Pathol Med. 2013;42(7):507-516. DOI:
                                                                        10.1111/jop.12030. PMID: 23301777.
                                                                     2. Siar CH, Yeo KB, Nakano K, et al. Strawberry gingivitis as the
                                                                        first presenting sign of Wegener's granulomatosis: report of a
Figure 1. Diffuse edematous and erythematous gingival hyperplasia
                                                                        case. Eur J Med Res. 2011;16(7):331-334. DOI: 10.1186/2047-
with petechial spots giving an appearance of a ripe strawberry.
                                                                        783x-16-7-331. PMID: 21813375. PMCID: PMC3352006.




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