In this NEJM Image in Clinical Medicine, a rash and gingivitis are seen in a woman with decreased vision.
Comment
The authors describe a young woman initially presenting with right nodular scleritis, purpura with overlying bullae on her legs and red-purple gingival swelling with petechial hemorrhages, otherwise known as “strawberry gingivitis.” She is later diagnosed with granulomatosis with polyangiitis (GPA) when further workup shows pulmonary nodules, glomerulonephritis, and proteinase 3 antineutrophil cytoplasmic antibody positivity.
GPA is an autoimmune vasculitis that can involve virtually every part of the body, including the gingiva, which is the presenting sign in 2% of patients. Clinicians should know that strawberry gingivitis, while rare, is nearly pathognomonic for GPA, so spotting it is a sure-fire way to raise your clinical diagnos…
Comment
The authors describe a young woman initially presenting with right nodular scleritis, purpura with overlying bullae on her legs and red-purple gingival swelling with petechial hemorrhages, otherwise known as “strawberry gingivitis.” She is later diagnosed with granulomatosis with polyangiitis (GPA) when further workup shows pulmonary nodules, glomerulonephritis, and proteinase 3 antineutrophil cytoplasmic antibody positivity.
GPA is an autoimmune vasculitis that can involve virtually every part of the body, including the gingiva, which is the presenting sign in 2% of patients. Clinicians should know that strawberry gingivitis, while rare, is nearly pathognomonic for GPA, so spotting it is a sure-fire way to raise your clinical diagnos…