Granulomatosis with Polyangiitis — MFDS Part 1 MCQ

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HardOral PathologyGranulomatosis with PolyangiitisMFDS Part 1

A 46-year-old patient presents with painful gingival enlargement that has not improved following periodontal debridement. The gingivae are diffusely erythematous, friable and haemorrhagic, with a granular, pebbled surface. The patient also reports persistent nasal crusting and intermittent epistaxis, and urinalysis shows blood and protein. Which systemic condition best accounts for this presentation?

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Correct answer: C — Granulomatosis with polyangiitis

The correct answer is granulomatosis with polyangiitis (GPA). Diffuse friable, granular and haemorrhagic gingival enlargement is the classic “strawberry gingivitis” appearance, a highly characteristic oral manifestation of GPA. Nasal crusting and epistaxis indicate upper respiratory involvement, while haematuria and proteinuria suggest associated glomerulonephritis. Crohn disease may cause mucosal cobblestoning, linear ulcers, tags and lip swelling, but not this gingival-systemic pattern. Sarcoidosis can produce granulomatous mucosal or salivary disease but does not classically cause strawberry gingivitis. Systemic lupus erythematosus is more associated with oral ulceration or lichenoid lesions. Addison disease causes diffuse or patchy mucosal pigmentation rather than haemorrhagic gingival enlargement.

Reference: Peraza Labrador AJ et al. Oral granulomatosis with polyangiitis: a systematic review. Clinical and Experimental Dental Research. 2023;9(1):100-111. https://pubmed.ncbi.nlm.nih.gov/36600477/