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.