Unusual presentation of pyostomatitis vegetans and its management

Abstract

A man in his early 50s was referred to the oral medicine clinic regarding a 6-month history of ulceration affecting the palate and gingivae. Intra-oral examination revealed multiple friable pustules on a background of erythema affecting the gingival sulci and 'snail-track' like ulceration affecting the palate. Histopathological analysis of the gingivae revealed features in keeping with a diagnosis of pyostomatitis vegetans (PV). Although he did not report any gastrointestinal symptoms, the patient was referred to gastroenterology and underwent colonoscopy and small bowel series examination. Colonic biopsies showed no features to suggest a diagnosis of inflammatory bowel disease (IBD). In 11 years since diagnosis of PV, the patient still shows no signs or symptoms suggestive of IBD. This case highlights a rare occurrence of PV without IBD, but emphasises the importance of appropriate referral to relevant medical specialities based on clinical and histopathological findings.

Keywords: Dentistry and oral medicine; Medical management.

Figure 1

Pustules on an erythematous background affecting the upper and lower anterior gingival segment.

Figure 2

‘Snail-track’ like ulceration affecting the palate.

Figure 3

Numerous micro-abscesses leading to suprabasal clefting, blister formations and erosions.