2 Lec 17 (Exam 3): Immune Mediated Disorders

Minor Aphthous Ulcers

patient presents with painful ulceration on the labial mucosa that is about 1cm and has erythematous borders. Patient was recently under a great deal of stress but sore resolved in about a week w/out scarring. What is the diagnosis?

non-keratinized mucosa

what type of mucosa do Minor Aphthous Ulcers present on?

Major aphthous ulcers

patient presents with painful ulceration on the labial mucosa that is about 1cm and has erythematous borders. Patient was recently under a great deal of stress. After 4 weeks patient comes back to your office and says that the ulcer just recently healed, and you notice a scar that it left behind. What is the diagnosis?

Herpetiform Aphthous Ulcers

ID the pathology:

T cells

Minor aphthous ulcers are mediated by what cells?

Allergies/hypersensitivity

Genetic predisposition

Hormonal influences

Nutritional deficiencies

Smoking cessation

Trauma

what are some things that could cause a Minor aphthous ulcer?

Behcet Syndrome

ID the pathology:

-Systemic vasculitis

-recurrent oral lesions PLUS 2 more (Arthritis, genital lesions, skin lesions, eye involvement)

-associated with HLA-B51

Behcet Syndrome

this condition is associated with HLA-B51:

Japanese/ Mediterranean

Behcet Syndrome most commonly affects what patient population?

Behcet Syndrome

patient presents with recurrent aphthous ulcer on the on the buccal mucosa. Patient also admits to similar lesions on the genitalia and well eye lesions. What is the diagnosis?

recurrent genital ulcerations

eye lesions

skin lesions

positive pathergy test

in order to be diagnosed with Behcet Syndrome, you must present with recurrent oral lesions and at least 2 other manifestations. What are the options?

Reactive arthritis (Reiter syndrome)

this condition is associated with HLA-B27:

male

Reactive arthritis (Reiter syndrome) has a _____ gender predilection

Reactive arthritis (Reiter syndrome)

ID the pathology:

-Arthritis, urethritis, uveitis, rash palms/soles

-male predilections

-HLA-B27

-associated with some infectious component (Chlamydia trachomatis Campylobacter,

Salmonella, Shigella and Yersinia)

Celiac disease

this condition is associated with HLA-DQ2:

Celiac disease

ID the pathology:

-Systemic immune-mediated disorder triggered by dietary gluten in genetically susceptible persons

-Damage to small intestine mucosa

-HLA-DQ2

-Gluten sensitivity

Celiac disease

serology tests tTG ab and EMA are used to diagnose what condition?

Oral ulcerations

Diarrhea Anemia

Abdominal pain

Chronic fatigue

Reduced bone density

signs and symptoms for Celiac disease include:

Crohn disease

ID the pathology:

-Chronic, relapsing, inflammatory bowel disorder

-Genetic, immunologic and environmental

-Alteration of the intestinal microbiome or disruption of the mucosal epithelium

-symptoms include:

Oral ulcerations (30%) (lips, gingiva,

mucobuccal fold). Upper lip swelling,

Diarrhea, abdominal pain, Granulomas on biopsy

Cyclic neutropenia

ID the pathology:

-Rare hematological condition characterized by cyclic/fluctuations in neutrophils

-autosomal dominant

-susceptible to opportunistic infections

-Oral ulcerations

Periodic fever, aphthous stomatitis, pharyngitis and adenitis

What does PFAPA stand for?

Sarcoidosis

ID the pathology:

-Multisystem inflammatory disease characterized by development of noncaseating granulomas

-Bimodal: 25-35 yrs and 45-65 yrs

-Most often in African-Americans (90%)

F>M

Fever, fatigue, anorexia, respiratory symptoms, visual problems dry cough, dyspnea, chest discomfort

Skin lesions (25%)

Head and neck (10-15%)

Oral Lesions: Well circumscribed brown-red or violaceous

papules, plaques or nodules

Submandibular lymphadenopathy, and/or xerostomia

Sarcoidosis

this oral pathology is associated with histoligical granulomatous formation:

African-Americans

Sarcoidosis most commonly affects what patient population?

Heerfordt syndrome

this syndrome is associated with sarcoidosis and is characterized by parotid swelling, uveitis, and facial nerve palsy:

Lofgren syndrome

this syndrome is associated with sarcoidosis and includes erythema nodosum, bilateral hilar lymphadenopathy, arthralgia:

Melkersson-Rosenthal syndrome

ID the pathology:

◦Facial paralysis

◦Fissured tongue

◦Cheilitis granulomatosa

Orofacial Granulomatosis

ID the pathology:

-Clinical presentation Lips-most common

location (cheilitis granulomatosa)

-Nontender, persistent swelling Intraoral- edema, ulcers, papules

-Idiopathic disorder (diagnosis based on exclusion)

-Abnormal immune reaction

Facial paralysis

Fissured tongue

Cheilitis granulomatosa

What is the Melkersson-Rosenthal syndrome triad?

Cheilitis granulomatosa of Miescher

ID the pathology:

persistent lip swelling is the only manifestation noted in patients with cheilitis granulomatosa

Granulomatosis with Polyangiitis (GPA) Wegeners

ID the pathology:

-Destructive and progressive, multiorgan autoimmune disease

- superficial form includes Strawberry gingivitis and Nasal symptoms

◦Vasculitis

◦Antineutrophil cytoplasmic antibodies (ANCAs)

Oral manifestions:

◦Hyperplastic gingiva

◦Ulcerations

◦Labial mucosal nodules

Allergic Contact Stomatitis

ID the pathology:

-Pt using new cinnamon toothpaste

Symptoms:

Burning sensation, *sloughing of mucosa

Itching/tingling

Signs:

Sloughing tissue Erythema

Lichenoid Contact Reaction to Dental Restorative Material

ID the pathology:

-Hypersensitivity reaction (Type IV)

-Occurs in the location in contact with the material, Mostly amalgam

-Appears lichenoid clinically and histolopathologically

-Patch test positive

-unilateral presentation

Angioedema

ID the pathology:

-Diffuse edematous swelling of soft tissues •

Affects subcutaneous/submucosal tissues

Causes

◦Type I Hypersensitivity (IgE)

◦Contact allergic reaction

◦Drugs (ACE Inhibitors)-occurs within hours of use

◦Activation of complement pathway

-◦Rapid onset; IgE mediated

◦Affects face, lips, tongue, pharynx, larynx Itching Erythema