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GPA Oral Features — MFDS Part 1 MCQ

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HardHuman DiseaseGPA Oral FeaturesMFDS Part 1

A 46-year-old presents with rapidly progressive gingival swelling and bleeding that have not improved despite meticulous plaque control. They also report recurrent epistaxis, blood-stained nasal crusting, persistent sinus symptoms and newly detected microscopic haematuria. Which oral pattern would most strongly support the suspected systemic diagnosis?

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Correct answer: C — Friable red-purple granular gingival enlargement with destructive palatal ulceration progressing to perforation

The systemic pattern suggests granulomatosis with polyangiitis (GPA), and option C describes its most characteristic oral presentation. “Strawberry gingivitis” is a friable, erythematous-to-purple, granular gingival enlargement that may precede other manifestations. GPA can also cause rapidly progressive oral ulceration and destructive granulomatous lesions resulting in palatal perforation. Reticular white striae with desquamative gingivitis suggest oral lichen planus. Cobblestoning, lip swelling and mucosal tags favour orofacial granulomatosis or Crohn disease. Migratory circinate lingual lesions describe geographic tongue. Xerostomia, cervical caries and candidosis are more consistent with salivary hypofunction, including Sjögren syndrome. ANCA results can support GPA but must be interpreted with the clinical findings and are not independently diagnostic.

Reference: Nico MMS, Pinto NT, Lourenço SV. From strawberry gingivitis to palatal perforation: The clinicopathological spectrum of oral mucosal lesions in granulomatosis with polyangiitis. Journal of Oral Pathology & Medicine. 2020;49(5):443-449. https://pubmed.ncbi.nlm.nih.gov/32133698/