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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 26  |  Issue : 2  |  Page : 219-221

Plasma cell gingivitis: A case report


Department of Oral Medicine and Radiology, Swami Devi Dyal Hospital and Dental College, Panchkula, Haryana, India

Date of Submission23-Aug-2014
Date of Acceptance28-Sep-2014
Date of Web Publication30-Oct-2014

Correspondence Address:
Aravinda Konidena
Flat No. 204, New Aashiana Apartments, GH 18, MDC, Sector 5, Panchkula, Haryana - 134 114
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.143710

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   Abstract 

Plasma cell gingivitis (PCG) is a rare condition of the gingiva, characterized by infiltration of plasma cells. The etiology is largely unknown, but it is thought to be due to a hypersensitivity reaction to an allergen. We report an interesting case of plasma cell gingivitis in a 28-year-old male patient, suffering from muscular dystrophy type II, diagnosed by histopathological examination of the excised gingival tissue, which was necessitated due to the refractory nature of the lesion to conventional treatment. The patient responded to topical 0.1% triamcinolone acetonide and 5 mg Levocetirizine.

Keywords: Gingival enlargement, gingivitis, muscular dystrophy, plasma cell, plasma cell gingivitis


How to cite this article:
Konidena A, Puri G, Jatti D, Singh S. Plasma cell gingivitis: A case report . J Indian Acad Oral Med Radiol 2014;26:219-21

How to cite this URL:
Konidena A, Puri G, Jatti D, Singh S. Plasma cell gingivitis: A case report . J Indian Acad Oral Med Radiol [serial online] 2014 [cited 2020 Aug 14];26:219-21. Available from: http://www.jiaomr.in/text.asp?2014/26/2/219/143710


   Introduction Top


Plasma cell gingivitis (PCG) is a rare gingival condition characterized by infiltration of the plasma cells. The etiology is largely unknown, but thought to be due to a hypersensitivity reaction to an allergen. The identification of a specific allergen may not always be possible. [1],[2] Some common allergens previously attributed are chewing gums, certain components of toothpastes, cinnamon, mint, red pepper, khat leaves, and so on. This condition has hence been classified into three categories, based on the etiology:

  1. PCG due to allergens.
  2. PCG due to neoplastic origin.
  3. PCG due to unknown cause. [1],[2]


Irrespective of the etiology, PCG usually presents as a red, edematous enlargement of the gingiva, which is friable and bleeds easily. This unusual condition is also known as atypical gingivostomatitis, idiopathic gingivostomatitis and allergic gingivostomatitis, especially when accompanied by cracking and fissuring of lips and ulceration of the oral mucosa.


   Case Report Top


A 28-year-old male patient reported to the Department of Oral Medicine and Radiology with a chief complaint of reddish swelling on the gums of the upper front teeth, of a two-month duration. The patient initially noticed a small swelling of the gums and consulted a dental surgeon. He was given medication and was treated by oral prophylaxis, without any significant improvement in his condition. There was a gradual increase in the gum swelling, which was painless, but associated with bleeding on biting with his front teeth. The recent change of oral hygiene products like toothpaste or consumption of chewing gum were denied by the patient. There was no loss of appetite, fever or lack of sleep. The medical history of this patient was significant for muscular dystrophy type II, with an inability to walk or move the lower limbs since the last five years [Figure 1]. Both his brother and sister were affected with the same condition, differing only in severity. However, his family history was not significant for gingival complaints. The patient was an occasional smoker since the last three years.
Figure 1: Patient unable to walk due to muscular dystrophy type II

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The patient was confined to a wheelchair and needed assistance to perform his daily activities. He had a dolichocephalic skull, short neck, scoliosis of the spine to the left side, and wasting of the legs.

Oral examination revealed a fiery red gingival enlargement of the marginal, papillary, and attached gingiva of the right maxillary central incisor, with a small 2 × 2 mm outgrowth from the mesial portion of the marginal gingiva [Figure 2]. There was bleeding on probing, with loss of stippling and contour. It had a soft consistency and it was nontender in nature. There was a gingival pocket of depth 5 mm on the mesiobuccal and distobuccal point angle. The mandibular incisors also showed a similar presentation [Figure 3] in addition to the right mandibular canine. There was generalized spacing between the teeth and the right maxillary lateral incisor was missing. Mild calculus was detected with respect to the mandibular anteriors and generalized stains were present [Figure 4]. The possibility of tuberculous gingivitis, chronic desquamative gingivitis and plasma cell gingivitis was considered. A complete hemogram and a routine biochemical and radiographic examination did not show any abnormality. Excisional biopsy of the outgrowth was done on the right maxillary right central incisor. Gingivoplasty was performed to maintain the contours. A protective periodontal dressing was applied and the patient was recalled after one week. The postoperative healing was uneventful and oral prophylaxis was done meticulously. The histopathological examination revealed sheets of round, plasma cells, suggestive of plasma cell gingivitis [Figure 5]. The patient was then advised 5 mg of Levocetirizine once daily and topical application of 0.1% triamcinolone acetonide for one week. The patient responded well to the treatment.
Figure 2: Fiery red gingiva with respect to right maxillary central incisor

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Figure 3: Fiery red gingiva of the mandibular incisors

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Figure 4: Calculus on mandibular anteriors

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Figure 5: Histopathological examination revealing infiltration of the plasma cells

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   Discussion Top


Plasma cell gingivitis is a rare condition, characterized by diffuse and massive infiltration of the plasma cells into the connective tissue. The first case was reported by Kerr et al. in 1981, when they observed gingival enlargement in gum chewers, which disappeared following the discontinuation of the chewing habit. [1] Plasma cell gingivitis has been classified into three types by Garguilo, Timms et al., as an immunological reaction to allergens, neoplasia or of unknown origin. [1],[2],[3] In our case, the etiology was unknown (and hence, can be classified as the third variant of PCG).

Plasma cell gingivostomatitis is a similar condition, characterized by a triad of cheilitis, glossitis, and gingivitis. [3] Curto et al. reported that PCG is a type of plasma cell circum orificial mucositis or plasmacytosis circum orificialis. It has been reported to occur on the larynx, epiglottis, vulva, conjunctiva, and nasal aperture apart from the lips and tongue. [4] Plasma cell granuloma, also known as an inflammatory pseudotumor, inflammatory myofibroblastic tumor or xanthomatous pseudotumor is an uncommon non-neoplastic lesion used to describe an enlargement confined to one specific site. [5] The most common location of occurrence is the lungs, but it may also be found in the brain, kidney, heart, and rarely in the gingiva. In our case, the involvement was limited to the gingiva of the anterior segment of the jaws.

Clinically, PCG presents as a diffuse reddening, together with edematous swelling of the gingiva, with a sharp demarcation along the mucogingival border. In our case, the patient presented with a fiery red gingival enlargement, localized to the anterior segment of the jaws, refractory to oral prophylaxis. These findings are consistent with earlier reports. [1],[2],[3] Although the co-existence of PCG with aggressive periodontitis and psoriasis has been reported, no such association has been reported earlier with muscular dystrophy. [6]

The patient's failure to respond appropriately to initial periodontal therapy necessitated a biopsy of the lesion. Histopathological examination of PCG reveals plasma cell infiltration in a dense collagenous stroma. Histologically, this condition must be differentiated from other aggressive conditions, such as, leukemia, plasmacytoma, multiple myeloma, and Waldenstrom's macroglobulinemia, to facilitate early treatment for a better prognosis. [1],[2]

Several medical and surgical therapies have been tried for the management of plasma cell gingivitis, with variable success. The medical treatments tried include, topical/systemic antihistaminics, corticosteroids, antimicrobials, and surgical modalities, including, excision by laser, electrocoagulation, and so on. [3],[6] Our patient responded to 0.1% topical triamcinolone acetonide and 5 mg Levocetirizine, in addition to oral prophylaxis.


   Conclusion Top


The importance of detailed history-taking, examination, and conduction of appropriate diagnostic tests, to arrive at a definitive diagnosis, is emphasized. An early diagnosis would direct the clinician toward an appropriate treatment plan, especially for unusual conditions masquerading as common lesions, which are refractory to conventional therapy.

 
   References Top

1.
Elavarasu S, Thangakumaran S, Karthik SJ, Arthie T. Plama cell gingivitis of unknown origin. J Indian Acad Dent Specialists 2010;1:34-8.  Back to cited text no. 1
    
2.
Imran F, Rajan S, Vijay G. A case of plasma cell granuloma of unknown cause. J Orofac Res 2012;2:235-7.  Back to cited text no. 2
    
3.
Janam P, Nayar BR, Mohan R, Suchitra A. Plasma cell gingivitis associated with cheilitis: A diagnostic dilemma! J Indian Soc Periodontol 2012;16:115-9.  Back to cited text no. 3
    
4.
Román CC, Yuste CM, González MA, González AP, López G. Plasma cell gingivitis. Cutis 2002;69:41-5.  Back to cited text no. 4
    
5.
Manohar B, Bhuvaneshwari S. Plasma cell granuloma of the gingiva. J Indian Soc Periodontol 2011;15:64-6.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Parashis AO, Vardas E, Tosios K. Generalized aggressive periodontitis associated with plasma cell gingivitis lesion: A case report and non-surgical treatment. Clinical Advances in Periodontics 2013;84:1-12.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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