Strawberry gingivitis

Strawberry gingivitis: A diagnostic feature of gingival Wegener's granulomatosis!
A 42 year old woman presented to the dermatology clinic with a 6 week history of rapidly progressive, painful gingival hyperplasia. She had recurrent epistaxis, and three necrotic ulcers had developed on her face over the previous 4 weeks. An oral examination revealed gingival hyperplasia with a granular and hemorrhagic appearance typical of “strawberry gingivitis.” Laboratory test results showed an elevated titer of antineutrophil cytoplasmic antibodies with a cytoplasmic staining pattern (c ANCA), and an enzyme-linked immunosorbent assay for anti–proteinase 3 antibodies was positive. The serum creatinine level and urinalysis results were normal. Computed tomography of the head and chest revealed normal paranasal sinuses and multiple pulmonary nodules. A diagnosis of granulomatosis with polyangiitis was established on the basis of these clinical and laboratory findings. Strawberry gingivitis is a rare manifestation of granulomatosis with polyangiitis, and its clinical presentation is highly suggestive of the disease.