Orofacial findings in chronic granulomatous disease: report of twelve patients and review of the literature

Abstract

Background: Chronic granulomatous disease is an extremely rare primary immunodeficiency syndrome that can be associated with various oral complications. This can affect high number of patients. However, data on oral complications is sparse. Here we will review the literature and describe the orofacial findings in 12 patients.

Findings: The age range was 5-31 years. Oral findings were variable, and reflected a low level of oral hygiene. They included periodontitis, rampant caries, gingivitis, aphthous-like ulcers, and geographic tongue. One patient had white patches on the buccal mucosa similar to lichen planus. Another patient had a nodular dorsum of the tongue associated with fissured and geographic tongue. Biopsies from the latter two lesions revealed chronic non-specific mucositis. Panoramic radiographs showed extensive periodontitis in one patient and periapical lesions in another patient.

Conclusion: Patients with chronic granulomatous disease may develop oral lesions reflecting susceptibility to infections and inflammation. It is also possible that social and genetic factors may influence the development of this complication. Therefore, oral hygiene must be kept at an optimum level to prevent infections that can be difficult to manage.

Figure 1

Oral findings in patient A4. Rampant caries and gingivitis.

Figure 2

Oral findings in patient A4. A panoramic radiograph showing multiple periapical lesions related to lower molars (arrows).

Figure 3

Oral findings in patient A4. Geographic tongue and the site of nodular lesion biopsy.

Figure 4

Oral findings in patient A4. Hyperkeratosis, acanthosis, and diffuse chronic nonspecific mucositis (H & E, ×40).

Figure 5

Oral findings in patient E8 showing white lesions (arrows) in the form of thin striations affecting the buccal mucosa.