Sarcoidosis and its oral manifestations: a case report study
Shahabinejad M1,2, Delavarian Z1,3, Zamani T4*, Fallah Toosi F5
1: Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
2: Assistant professor of oral and maxillofacial pathology, Oral & Maxillofacial pathology Department, Mashhad University of Medical Sciences, Mashhad, Iran. ShahabinejadM@mums.ac.ir
3: Professor of oral and maxillofacial medicine, Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. delavarianZ@mums.ac.ir
4: Postgraduate Student of Oral and Maxillofacial Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. ZamaniT991@mums.ac.ir
5: Mashhad University of Medical Sciences, Mashhad, Iran. fatemehfallahtoosi@gmail.com
*: Corresponding author
Abstract
A patient was referred to the oral medicine department with symptoms of redness and swelling of the lips and cheek, and intra-oral lesion. Biopsy was taken and laboratory factors were higher than normal, suggesting diagnosis of sarcoidosis. In this study we analyze the oral findings associated with sarcoidosis.
Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.
Introduction
Sarcoidosis is a multisystem granulomatous disorder of unknown etiology in which T lymphocytes, mononuclear phagocytes, and granulomas destruct the tissues affected(1). Boeck termed it sarcoidosis (Greek meaning “flesh-like condition”)(2).
The diagnosis of sarcoidosis is made by the presence of supporting clinical factors with the presence of noncaseating granulomas in the biopsy sample. And elevated serum angiotensin-converting enzyme (ACE) levels could support the diagnosis(1-3). It shows an increased prevalence in females(2). The disease may present acutely or demonstrate a chronic course with periods of remission.
In two-third of the patients, oral signs were the first manifestation of the disease. And the most involved intra-oral soft tissue site is the buccal mucosa, gingiva, lips, tongue, and palate(2). Treatment of this disease may range from only observation of the patient, to taking systemic corticosteroids and steroid-sparing agents(1).
In this study, we emphasize on the oral manifestations of sarcoidosis, a multi-factorial disease that involves vital organs. Because the patient’s first symptoms appeared in the mouth, it is important for dentists to be aware of these oral signs and pay close attention not to ignore it. Also, in this stage, the disease has a better prognosis.
Case Presentation
A 47-year-old woman was referred to the Oral and Maxillofacial department at Mashhad University of Medical Sciences, for redness on the skin of her left cheek, and non-tender diffuse swelling of lips (especially the upper lip) that had appeared five months previously. She declared that no improvement was obtained with prescription and use of Tetracycline ointment and Amoxicillin. Her medical records revealed a history of hypertension and hypothyroidism and usage of Captopril 250 mg (twice a day) and Levothyroxin 50 mg.
Extraoral examination showed diffuse. A swelling with slight redness in the lower lip and edematous inflammation of the upper lip with redness, particularly in the upper left area with mild swelling and erythematous on the skin of the left cheek. Asymmetry is clearly observed with lymphadenopathy in the left submandibular area with firm consistency but without tenderness in touch.