[Foreign material in the gingival tissues admixed with a clinical picture of Mucous Membrane Pemphigoid: A coincidence or inter-related conditions?].

Abstract

We present a case of a 74-year old female who complained of chronic vesicular and ulcerative lesions distributed on her gingivae. The lesions did not respond to conventional periodontal treatment. The clinical appearance was consistent - with vesiculo-bullous conditions, such as Pemphigus Vulgaris and Mucous Membrane Pemphigoid. These conditions have an auto- immune etiology, whereby pathologic auto-antibodies are generated against structures that constitute the epithelial cell-cell or cell-connective tissue attachment systems. Accurate diagnosis is mandatory due to the high risk, at least in part of them, to spread to extra- oral sites, such skin, eyes and other types of mucosae and cause severe morbidity and even death. Diagnosis is based on routine biopsy aimed to identify the characteristic histomorphological features and on direct immunofluorescence that highlights the type and pattern of the deposition of the auto-antibodies with the affected tissue. The present biopsy did not show features of a vesiculo-bullous condition. However, the presence of a foreign material in the form of fine granules was highlighted by polarized microscopy. Immunofluorescence revealed a %pattern of auto-antibodies that was supportive of Mucous Membrane Pemphigoid. In lack of involvement of any other oral site, the patient has been treated with local agents, as commonly accepted. The present case emphasizes the need to consult specialists from various disciplines, especially in those cases where the clinical response to a common practice is not as expected. Furthermore, diagnosis is not always straightforward, and sometimes a pathologic condition may be the "product" of more than one single etiology.