ALLERGIC AND IMMUNOLOGIC DISEASES OF THE ORAL CAVITY

-BY MAHAK RALLI(THIRD BDS)

SARCOIDOSIS Multisystem granulomatous disease of

unknown origin It is characterized by formation of uniform,

discrete, compact, non-caseating epitheloid granulomas.

Etiology is unknown, but both infective and non-infective agents have been implicated.

Infective etiology is favored with focus on Mycobacterium and Propionibacterium.

SARCOIDOSIS Blacks are more affected than whites. Affects young adults and presents with hilar

lymphadenopathy, pulmonary infiltration, and skin and eye lesion.

It may involve practically any site, including lungs, skin, lymph nodes, salivary glands, spleen and bones and mouth.

Sarcoidosis is characterized by a depression of delayed-type hypersensitivity suggesting impaired cell-mediated immunity and raised or abnormal serum immunoglobulins suggesting lymphoproliferation.

CLINICAL FEATURES OF SARCOIDOSIS

It is an insidious disease. Sypmtoms are not severe.

Most commonly seen in young and middle-aged adults, but it may occur later in life.

More common in blacks. Mild malaise and cough are chief features. Involvement of a specific organ is evidenced

by dysfunction of that organ. Cutaneous lesion may be the only distinct

manifestation in 25-35% cases.

Eye lesions in sarcoidosis

CLINICAL FEATURES OF SAROIDOSIS

The cutaneous lesions appear as multiple, raised red patches that occur in groups, grow slowly, and do not tend to ulcerate or crust.

Erythema nodosum is seen in 15% cases. Involvement of lymph nodes or salivary

glands is manifested only by nodular enlargement.

Heaptomegaly and spleenomegaly may occur owing to presence of disease in the liver and spleen.

Erythema nodosum

Lymph node involvement

ORAL MANIFESTATION OF SARCOIDOSIS

There are no cases of sarcoidosis of the oral cavity and jaws reported in literature. It is hence difficult to describe typical lesions.

Lesions on the lips that have been reported were manifested clinically as small, pauplar nodules or plaques, or resembled herpetic lesions or ‘fever blisters’.

On palate and buccal mucosa, lesions are bleb-like containing a clear yellowish fluid, or as solid nodules.

It also appears that sarcoid may produce diffuse destruction of bone.

HISTOLOGIC FEATURES OF SARCOIDOSIS

Sarcoid lesions closely resemble proliferative nodules of tuberculosis and differential diagnosis is difficult to establish.

No acid-fast organisms can be demonstrated in tissue section of sarcoidosis.

Nests of epitheloid cells, with multinucleated giant cells are one of the chief microscopic features.

T and B cells along with various immunoglobulins can be demonstrated b appropriate immunofluorescence.

HISTOLOGIC FEATURES OF SARCOIDOSIS

Caseation and necrosis do not occur, although the granuloma ultimately transforms into a solid amorphous, eosinophilic and hyaline mass as it ages.

DIFFERENCE WITH TUBERCULOSIS

Tuberculin reaction is as positive in sarcoid patients as it is in the general population.

Low incidence of complement-fixing antibodies against tuberculosis is seen. If present, antibody titre is very low.

DIAGNOSIS OF SARCOIDOSIS An intracutaneous test, the Kvim-

Siltzbach test which utilizes a suspension of human known sarcoidal tissue as a test agent.

The test has indicated a high degree of specificity with a few false positive reactions.

UVEOPAROTID FEVER It is a form of sarcoidosis in which

enlargement of the parotid glands, accompanied by inflammation of the uveal tracts of the eye and cranial nerve involvement, and even the lacrimal glands may be swollen, all features suggestive of Mikulicz’s disease or Sjogren’s syndrome.

Clinical features A chronic, low grade fever is often

present Complains of lassitude, malaise and

vague gastrointestinal disturbances or even nausea, and vomiting.

Xerostomia. A patchy erythema of skin in early

stages of the disease. Enlargement of cervical lymph nodes

CLINICAL FEATURES Most common eye lesion in uveoparotitis,

and often the earliest symptom is uveitis, but conjuctivitis, keratitis and corneal herpes among others have also been reported.

Uveitis may begin unilaterally, but becomes bilateral in most cases and results in permanent visual impairment.

Unilateral or bilateral seventh nerve paralysis occurs in one-third to one-half of all cases.

Midline lethal granuloma It is the most unusual condition,

resembling a serious infection, which has been described as an idiopathic progressive destruction of nose, paransal sinuses, palate, face and pharynx.

Many different specific diseases may have the same clinical manifestation as originally described for midline lethal granuloma.