Recommended
More Related Content
Similar to Case Study E Presentation
Similar to Case Study E Presentation (20)
Recently uploaded
Recently uploaded (20)
Case Study E Presentation
- 1. CASE STUDY E CREATED BY KAYLA ROBINSON
- 2. PATIENT DEMOGRAPHICS 47 year-old male presenting with…. • Diffuse gingival redness since late October 2017 • Initially started in the lower left canine area • Progressively spread throughout the dentition • Reports that lesion was painful when eating and brushing • Tissue bled easily with any contact and exhibited a positive Nikolsky sign
- 3. PERIODONTIST FINDINGS Intense erythema on the facial of teeth… • #12-13 • #19-25 • #28-29 • Most intense redness was on #20-25
- 4. PICTURE TAKEN AT THE PERIODONTIST • Note the diffuse red/eroded left and anterior mandibular gingiva and sloughing epithelium
- 5. MEDICAL HISTORY • Significant for benign atrial fibrillation & non-alcoholic fatty liver disease • Rare alcohol consumption • No use of any tobacco products or recreational drugs • Current medications: • Propranolol • Fish Oil
- 6. CLINICAL FINDINGS • In late October 2017 this patient complained about red painful gingival lesions bleeding when brushing • Lesions were confined to gingiva of tooth #22 • Over a six-month period it progressively spread on other parts of the mandibular gingiva and also involved the maxillary gingiva
- 7. TREATMENT • Under local anesthesia, two incisional biopsies were taken • One in formalin • Second in Michel's solution for immunofluorescent staining • At biopsy, the area bled profusely, and appropriate measures were taken to stop the bleeding
- 8. EXCISIONAL BIOPSY • Histologic examination reveals one piece of soft tissue composed of surface epithelium splitting above the basal cell layer • The spinous layer shows evidence of acantholysis • The basal cell layer is intact and part of the connective tissue • The latter is infiltrated by a mixed inflammatory population • Direct immunofluorescent staining shows positive intercellular staining of the spinous layer cells with antibody to IgG and C3
- 9. LOWER POWER (40X): DEMONSTRATING MOSTLY DETACHED EPITHELIUM ABOVE THE BASAL CELL LAYER. THE BASAL CELLS ARE INTACT AND CLEARLY ANCHORED ON THE BASEMENT MEMBRANE. THE DETACHED EPITHELIUM SHOWS EVIDENCE OF ACANTHOLYSIS. THE CONNECTIVE TISSUE IS INFILTRATED BY MIXED AND CHRONIC INFLAMMATORY CELLS.
- 10. HIGHER POWER (100X): STAINED SECTION CLEARLY DEMONSTRATING THE EPITHELIAL DETACHMENT ABOVE THE BASAL CELL LAYER.
- 11. HIGH POWER (200X): STAINED SECTION, FOCUSING ON THE SPLIT OF THE SURFACE EPITHELIUM, THE BREAKDOWN OF THE SPINOUS LAYER AND THE ACANTHOLYTIC CELLS
- 12. POSSIBLE DIAGNOSIS • Erosive Lichen Planus • Mucous Membrane Pemphigoid • Pemphigus Vulgaris
- 13. EROSIVE LICHEN PLANUS • Epithelium separates from connective tissues • Resulting in erosions, bullae, or ulcers • Can present with gingival lesions • Distributed symmetrically in the oral cavity (bilaterally) • Middle aged • Slight female predilection • Commonly found on buccal mucosa • Most cases are asymptomatic
- 14. MUCOUS MEMBRANE PEMPHIGOID • Lesions result from cleavage of the epithelium from the underlying connective tissue • Nikolsky sign can be present • The most common sight is the gingiva • Erythema to ulcerated appearance • No acantholysis • Occurs in multiple locations in the oral cavity • More common in females • Blistering on head and neck • Lesions heal with scarring
- 15. PEMPHIGUS VULGARIS • Most cases occur between 40-50 • Acantholysis present (breakdown of cellular adhesion) • No gender predilection • Positive Nikolsky sign • Diagnosis made form biopsy and microscopic examination • Immunofluorescence testing shows circulating autoantibodies • Present in 80% of patients
- 16. REFERENCES • NORD. (2016). Mucous Membrane Pemphigoid. Retrieved from https://rarediseases.org/rare-diseases/mucous-membrane- pemphigoid/ • Phelan, I. A. (2014). Oral Pathology for the Dental Hygienist. St. Louis: Saunders, Elsevier.