Gingival Pemphigus Vulgaris-Challenges and Solution :  A Case Report

Pemphigus vulgaris (PV) is a potentially life threatening and rare mucocutaneous disease that usually manifests first in the oral cavity and may later spread to the skin or other mucous membrane. Lesions may occur anywhere on the mucosa but it is unusual for PV to present over the gingiva as a primary site of involvement. A 64 year old female patient reported with a chief complaint of reddish, painful gums with burning sensation since 8 years. The diagnosis of PV is based on clinical findings (Nikolsky’s sign positive) and confirmed by histopathological analysis. Medications were prescribed as per indications and requirements. Oral hygiene instructions were given. No recurrence was observed at 1½ year of follow-up. Thus, this case serves to enhance our awareness of gingiva as a site at which systemic disease can manifests itself.

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Isolated Crohn’s Disease of the Appendix Presenting as Acute Appendicitis in a 60-Year-Old South Asian Female: A Case Report, Review of Literature, and Follow-Up Recommendations

Case Reports in Surgery ◽

10.1155/2019/5285417 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Pamathy Gnanaselvam ◽

Dhanushka N. Weerakoon ◽

W. A. M. Wijayasuriya ◽

Vishva Samidi Mohottala ◽

B. M. E. S. Sinhakumara ◽

...

Keyword(s):

Crohn’S Disease ◽

Case Report ◽

Crohn's Disease ◽

Acute Appendicitis ◽

Clinical Findings ◽

Additional Treatment ◽

Histological Evaluation ◽

Histopathological Analysis ◽

Review Of Literature

The isolated appendiceal Crohn’s disease without preceding bowel symptoms is a rare phenomenon, especially in older patients. In this case report, we present a 60-year-old female with isolated appendiceal Crohn’s disease presenting with acute appendicitis. She presented with classical features of appendicitis with elevated inflammatory markers. She underwent an appendectomy which showed an excessively swollen, oedematous, and reddish appendix with swelling extending to the base of the caecum. Histological evaluation was suggestive of Crohn’s disease, and subsequent colonoscopy was unremarkable. Following appendectomy, she was asymptomatic without any recurrence of disease. The atypical morphological appearance of the appendix should raise suspicion of Crohn’s disease. This case highlights the importance of histopathological analysis of the specimen, especially in abnormal clinical findings. The prognosis of such patients seems to be good, and additional treatment is rarely needed.

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Osteomyelitis of frontal sinus, zygomatic bone and maxilla

BMJ Case Reports ◽

10.1136/bcr-2020-236163 ◽

2020 ◽

Vol 13 (9) ◽

pp. e236163

Author(s):

Anshul Rai ◽

Anuj Jain ◽

Rishi Thukral

Keyword(s):

Maxillary Sinus ◽

Frontal Sinus ◽

Systemic Disease ◽

Lateral Nasal Wall ◽

Maxillary Bone ◽

Zygomatic Bone ◽

3D Ct Scan ◽

Orbital Wall ◽

Patient Reported

A 52-year male patient reported with loosening of right upper jaw. He has no pain or discharge, or any acute symptoms and systemic disease. Intraoral examination reveals necrosed maxillary bone. He also has no sickle cell disease, hepatitis, HIV or tuberculosis. 3D CT scan reveals destruction of maxilla, maxillary sinus, lateral nasal wall, superior and inferior orbital wall, zygoma and frontal bone(outer table). The clinical diagnosis of osteomyelitis was made. Under general anaesthesia, sequestrectomy was done with the help of Weber-Ferguson incision with infraorbital extension for maxilla, maxillary sinus, zygomatic bone, lateral nasal wall and infraorbital and medial wall of orbit. Frontal sinus region sequestrectomy was done via bicoronal flap. The patient was completely diseased free after 4 years follow-up.

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Bilateral gemination of maxillary permanent incisors: a case report

Journal of Research in Dentistry ◽

10.19177/jrd.v4e1201623-26 ◽

2016 ◽

Vol 4 (1) ◽

pp. 23

Author(s):

Pooja Singh ◽

Manish Jha ◽

Animesh Mutha ◽

Kirti Bahar

Keyword(s):

Chief Complaint ◽

Close Similarity ◽

Systemic Diseases ◽

Preventive Dentistry ◽

Vitamin Deficiencies ◽

Patient Reported ◽

History Of ◽

Tooth Number ◽

History Of Pain

Developmental dental disorders may be due to anomalies in tooth number, size, shape and structure. Gemination and fusion are anomalies of shape with close similarity but with different etiology. Gemination and fusion are anomalies of shape with close similarity but with different etiology. The etiology of germination is not fully understood environmental factors such as trauma, vitamin deficiencies, systemic diseases and certain genetic predisposition have been suggested as possible causes. A 9 year old male patient reported to the department of pedodontics and preventive dentistry Dr R Ahmed Dental College & Hospital with the chief complaint of unaesthetic upper front teeth on clinical examination. It was found that the upper central incisors were markedly large in size with buccolingual grooves present partially separating two halves of crown. The incisors were caries free and there was no history of pain or any discomfort. Since the roots were not completely formed the patient was kept on follow up for the treatment to be delivered.

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Penetrating Orbitocranial Injury With a Good Aesthetic and Functional Outcome: A Case Report

Iranian Journal of Neurosurgery ◽

10.32598/irjns.7.1.8 ◽

2021 ◽

Vol 7 (1) ◽

pp. 61-66

Author(s):

Youssef Fahde ◽

◽

Davis Mpando ◽

Mehdi Laghmari ◽

Houssine Ghannane ◽

...

Keyword(s):

Case Report ◽

Multidisciplinary Approach ◽

Violent Behavior ◽

Case Presentation ◽

Frontal Horn ◽

Patient Reported ◽

Long Term Follow Up ◽

Life Threatening

Background and Importance: Transorbitocranial assaults with sharp objects like a knife are rare neuro-ophthalmologic emergencies. However, they can have dramatic functional and life-threatening consequences. Our presentation aims to report the importance of an urgent multidisciplinary approach and to raise awareness among the general population on the importance of preventing violent behavior. Case Presentation: A 33-year-old man was a victim of a knife attack without obvious brain or ophthalmological lesions. The knife entered the medial part of the orbit. Neurological examination was normal, and Computed Tomography (CT) scan showed intracranial trajectory through the orbit to the frontal horn of the lateral ventricle. The knife was extracted without complications. The patient reported spectacular improvement in visual acuity without neurological or oculomotor deficit at long-term follow-up. In this case report, we will discuss the radiological diagnosis and surgical management of transorbital and orbitocranial injuries by foreign body penetration. Conclusion: Urgent multidisciplinary management in orbitocranial trauma by stabbing is mandatory to avoid life-threatening complications and irreversible damages.

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An Overview of Tools to Score Severity in Pediatric Inflammatory Bowel Disease

Frontiers in Pediatrics ◽

10.3389/fped.2021.615216 ◽

2021 ◽

Vol 9 ◽

Author(s):

Ron Shaoul ◽

Andrew S. Day

Keyword(s):

Disease Activity ◽

Age Groups ◽

Scoring Systems ◽

Clinical Findings ◽

Response To Treatment ◽

Cochrane Library ◽

Optimal Care ◽

Patient Reported ◽

Assessment Of Disease Activity

Background and Aims: The management of IBD entails the use of various treatments (nutrition, medications, and surgery) in order to induce and maintain remission. The assessment of IBD disease activity is based on a combination of symptoms, clinical findings, imaging, and endoscopic procedures. As in any disease, reliable assessment of disease activity or severity is required in order to plan relevant follow-up, decide on appropriate investigations, determine the best treatment option and subsequently assess response to treatment. It is important for proper documentation, follow-up, assessment of response to treatment and communication, especially in patients with IBD, to talk the same language by using validated and widely used scores for disease activity, endoscopic and radiologic activity, and patient reported outcomes both for clinical practice and research. This review aims to highlight key tools available for the assessment of disease activity or severity in individuals (especially children) with IBD.Methods: A literature search was performed using MEDLINE, Pubmed, and the Cochrane Library with the last search date of August 2020. Tools evaluating disease severity across various aspects (clinical, endoscopic, and radiological) were identified and discussed. Those tools validated and specific for children with IBD were included were available.Results: Over time a number of scoring systems have been developed to quantify clinical, endoscopic and imaging assessments in individuals with IBD. While some are exclusively for children or adults, others appear to have relevance to all age groups. In addition, some tools developed in adult populations are utilized in children, but have not expressly been validated in this age group.Conclusions: Although some available scoring tools are appropriate for children with IBD, others require consideration. The development and use of pediatric-specific tools is relevant and appropriate to optimal care of children and adolescents with IBD.

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Clinical Aspects and Conservative Dental Management of a Patient with Fibrodysplasia Ossificans Progressiva

The Journal of Contemporary Dental Practice ◽

10.5005/jp-journals-10024-1501 ◽

2014 ◽

Vol 15 (1) ◽

pp. 122-126 ◽

Cited By ~ 3

Author(s):

Francisco Artur Forte Oliveira ◽

Clarissa Pessoa Fernandes ◽

Kenia Samara Barbosa Araujo ◽

Ana Paula Negreiros Nunes Alves ◽

Fabrício Bitu Sousa ◽

...

Keyword(s):

Dental Treatment ◽

Clinical Findings ◽

Fibrodysplasia Ossificans Progressiva ◽

Clinical Aspects ◽

Heterotopic Ossifications ◽

Skeletal Malformations ◽

Dental Procedures ◽

Dental Management ◽

Oral Hygiene Instructions

ABSTRACT Aim To present the clinical findings of a patient with Fibrodysplasia Ossificans Progressiva (FOP), highlighting peculiarities of dental treatment in patients with this condition. Background FOP is a rare genetic disease characterized by skeletal malformations and ectopic ossifications in skeletal muscles, tendons, ligaments and aponeurosis. Exacerbation of these ossifications can be caused by dental treatment, resulting in disease progression. Case description A 26-year-old male patient with a diagnosis of FOP was referred to our service for dental treatment. The patient presented decreased mobility in peripheral joints (knees and elbows), postural disability (ankylosis of the vertebral column), lateral deviation and shortness of the hallux, as well as heterotopic ossifications on the hands and back. The implementation of conservative dental procedures, such as oral hygiene instructions and recurrent topical fluoride applications, were performed in addition to endodontic and restorative treatments. Brief dental appointments were conducted without using regional anesthesia or dental dam clamps. The dental chair was positioned at 45° to provide more comfort and to avoid exacerbating the disease. The patient has now completed 6 months of follow-up and is free of heterotopic ossifications resulting from dental treatment. Conclusion The dental treatment modifications implemented for the present case were sufficient to establish good oral health and to prevent the formation of heterotopic ossifications in the maxillofacial region. Clinical significance FOP is a rare disease dentists must familiarize themselves with to provide adequate, personalized treatment, which minimizes traumas that may exacerbate the disease. How to cite this article Oliveira FAF, Fernandes CP, Araujo KSB, Alves APNN, Sousa FB, Mota MRL. Clinical Aspects and Conservative Dental Management of a Patient with Fibrodysplasia Ossificans Progressiva. J Contemp Dent Pract 2014;15(1):122-126.

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RECURRENT SYNCOPE AS A SYMPTOM OF ELECTRICAL STORM – CASE PRESENTATION

Emergency Medical Service ◽

10.36740/emems202104111 ◽

2021 ◽

Vol 8 (4) ◽

pp. 271-273

Author(s):

Przemysław Skoczyński ◽

Paweł Pochciał

Keyword(s):

Ventricular Arrhythmias ◽

Electrical Storm ◽

Monitoring Equipment ◽

Case Presentation ◽

Diffi Cult ◽

Patient Reported ◽

Cardiology Clinic ◽

Life Threatening ◽

History Of

Dangerous ventricular arrhythmias leading to sudden cardiac death (SCD) are some of the most diffi-cult diagnostic challenges. They are often mildly symptomatic. Their often self-limiting nature means that they are difficult to capture on ECG. A 75-year old woman with chronic heart failure due to nonis-chemic cardiomyopathy reported to the cardiology clinic for a scheduled routine follow-up of the ICD, implanted three years prior as primary prevention of SCD. The patient reported recent episodes of sud-den weakness and described the episodes as hypotension. The patient associated it with too aggressive treatment of arterial hypertension. During the visit the patient experienced one of these episodes that she had previously described. The monitoring equipment in the clinic revealed ventricular tachycardia (VT). The history of the implanted ICD revealed many similar previous episodes including 5 episodes in the last 24 hours which led to a diagnosis of electrical storm. Dangerous ventricular arrhythmias may be mildly symptomatic and they are often underestimated by the patient. Fainting, especially in situa-tions unusual for the vasovagal reflex or orthostatic hypotension, should always arouse vigilance to-wards life-threatening ventricular arrhythmia.

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A Giant Primary Mediastinal Teratocarcinoma in a Male Adult

Case Reports in Surgery ◽

10.1155/2019/7123241 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Muneera Al-Khalifa ◽

Sara Alsaad ◽

Habib Al-Tareef ◽

Zaid Arekat ◽

Abdulla Darwish

Keyword(s):

Germ Cell ◽

Germ Cell Tumors ◽

Histopathological Analysis ◽

Sarcomatous Component ◽

Male Adult ◽

Tumor Studies ◽

Life Threatening ◽

Males And Females ◽

Midline Sternotomy

Germ cell tumors (GCTs) arise along the midline, in which 50-70% of extragonadal GCTs occur in the mediastinum. Malignant GCTs are more common in males, while benign GCTs occur equally in both males and females. This report presents a case of a giant primary mediastinal nonseminomatous GCT resected from a 35-year-old male who presented with dyspnoea and tightness in the chest. Thorough investigations including a chest MRI were done. It showed a 21×19×15 cm tumor. Thus, surgical resection of the tumor through a midline sternotomy was done. Histopathological analysis diagnosed the tumor as a primary mediastinal teratocarcinoma with a sarcomatous component. Eighteen-month follow-up showed no tumor recurrence. Mediastinal teratocarcinoma is a rare and life-threatening germ cell tumor. Studies recommend the use of chemotherapy prior to resection as an important step in its management. Close and regular follow-up postsurgical resection is advised.

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Kandisiasis Mulut sebagai Indikator Penyakit Sistemik

Majalah Kedokteran Gigi Indonesia ◽

10.22146/majkedgiind.15542 ◽

2012 ◽

Vol 19 (2) ◽

pp. 162

Author(s):

Satrya Ayu Erawatie Prayudha ◽

Bernadeta Esti Chrismawaty ◽

Dewi Agustina ◽

Goeno Subagyo

Keyword(s):

Diabetes Mellitus ◽

Early Identification ◽

Systemic Disease ◽

Oral Candidiasis ◽

Oral Lesion ◽

Clinical Findings ◽

Oral Health Education ◽

Patient Reported ◽

Polymorphic Type ◽

Teeth Extraction

Latar belakang. Kandidiasis mulut disebabkan oleh infeksi Candida. Kondisi imunokompromais seperti DM merupakan salah satu faktor predisposisinya. Diabetes mellitus (DM) merupakan penyakit metabolik yang sering tidak disadari dan menjadikan penderitanya rentan infeksi. Tujuan. Penulisan ini bertujuan untuk melaporkan kandidiasis mulut polimorfik pada pasien yang sebelumnya tidak terdeteksi DM. Kasus dan penanganan. Seorang laki-laki 57 tahun datang ke Klinik Gigi dan Mulut, RSUP Dr. Sardjito mengeluhkan gangguan pengunyahan. Keluhan dirasakan sejak 1 bulan terakhir akibat gigi sebalah kiri atasnya goyah. Pasien menggunakan gigi tiruan sebagian lepasan (GTSL) sejak 5 tahun yang lalu. Sejak awal, GTSL susah dilepas sendiri oleh pasien. Akhir-akhir ini, terdapat keluhan mulutnya gatal dan nafas berbau. Dilaporkan adanya penurunan berat badan hingga 9 kg pada 3 bula terakhir. Ekstra-oral normal, intra-oral tampak plak putih pada dorsum lidah, area eritematus pada palatum berhadapan dengan plat GTSL, gigi avulsi, luksasi disertai resesi. Berdasar anamnesis dan pemeriksaan klinis, lesi mulut mengacu pada kandidiasis mulut dan pasien dicurigai menderita DM. Rencana perawatan meliputi Komunikasi, Informasi, dan Edukasi, terapi antifungal, ortopantomogram (OPG) dan konsultasi medis terkait kecurigaan DM. Penatalaksanaan lesi mulut meliputi debridasi dan Nystatin topikal. Dua minggu kemudian, lesi mulut menunjukkan perbaikan. Hasil OPG dan kadar glukosa darah (KGD) mengindikasikan latar belakang DM. Ekstraksi dilakukan setelah DM terkontrol diikuti pembuatan protesa. Fungsi mulut kembali normal dan diinstruksikan pengelolaan KGD. Kesimpulan. Temuan klinis kandidiasis mulut dapat digunakan sebagai indicator adanya gangguan sistemik, pada kasus ini adalah DM. Identifikasi dini lesi mulut terkait gangguan sistemik dapat membantu penderita untuk memperoleh perawatan sistemik lebih awal. Background. Oral candidiasis is caused bt Candida infection. Immunocompromise condition such as diabetes is one of its predisposition. Diabetes mellitus (DM) is metabolic disorder that is often not realized by the sufferer and makes the sufferer susceptible to infection. Purpose. This paper is intended to report the polymorphic type of oral candidiasis in patient with previously undetected DM. Case and management. A 57 years old man complained of impaired mastication due to teeth luxation since last month. Patient has wearing removable partial dentures since 5 years ago, which was hard to removed by himself. Lately the patient experienced prickly under dentures and halitosis. The patient reported about lost of weight as 9 kg in 3 months. No abnormality found extraorally, and intraorally it found some velvety white plaque on dorsum of the tongue, erythematous area on mucosal bearing dentures, avulsion and luxation of the teeth. Based on history taking and clinical examination, oral lesion regarded as oral candidiasis and the patient suspected to have DM. Treatment planning were oral health education, antifungal therapy, taking an OPG, medical consultation because of possibility of DM. Treatments comprises as oral debridement and topical nystatin. Two weeks later, oral lesion showed improvement. It revealed that OPG and Blood Glucosa Level (BGL) result were referred to DM. After his DM controlled, teeth extraction was done followed by construction of new denture. Normal oral function returned, and patient instructed to maintain BGL. Conclusion. Clinical findings as oral candidiasis can be used as an indicator of the existence of the systemic disease, in this case are DM. Early identification of oral lesion associated systemic disease could help the patient to obtain early treatment.

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Extremely Rare Intraoral Presentation of Localized Amyloidosis

Case Reports in Dentistry ◽

10.1155/2021/5541320 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Luka Morelato ◽

Igor Smojver ◽

Sven Seiwerth ◽

Dragana Gabrić

Keyword(s):

Oral Surgery ◽

Systemic Disease ◽

Polarized Light ◽

Histopathological Analysis ◽

Alveolar Ridge ◽

Localized Amyloidosis ◽

Tissue Healing ◽

Maxillary Region ◽

Rule Out

Purpose. To present an extremely rare case of localized amyloidosis of the mucosa of the maxillary alveolar ridge. Case Report. A 71-year-old man was referred to the Department of Oral Surgery, School of Dental Medicine, University of Zagreb, for a persistent nodular formation in the edentulous ridge of the anterior maxillary region. The nodular formation had a reddish color, solid consistency, and an approximate size of 40 × 15 mm . Orthopantomographic imaging excluded bone resorption and defects. Histopathological assessments of the biopsy specimen showed that the stroma was occupied by a multiplied, partially hyalinized connective tissue. The samples were subsequently stained with Congo red, and collagen accumulation under polarized light showed an apple-green birefringence indicating amyloid. Subsequently, the nodular formation was completely excised and a maxillary total denture was made. The patient showed normal tissue healing with no sign of recurrence at a follow-up assessment 1.5 years after the procedure. Conclusion. This is only the third reported case of localized amyloidosis of the alveolar ridge mucosa. Histopathological analysis is the first step for diagnosis, but systemic tests, blood counts, urinalysis, bone marrow biopsy, electrocardiography, and digestive endoscopy are recommended to rule out a systemic disease.

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