Wegener's granulomatosis presenting as unhealing palatal ulceration - A case report

This article reports a case of 45-year-old female presented with pain and swelling in lower jaw with generalised burning sensation over the gums, mobility in upper anterior teeth and difficulty in feeding. On intra oral examination diffuse reddish inflamed and fragile gingiva was noticed with granular appearance. Painful whitish sloughed and indurated ulcerative lesion with erythematous margins was found over midpalate to buccal mucosa over anterior border of ramus. Consistent radiographic examination revealed cavitatory defect over right pleural base. List of various diagnostic possibilities has been given as differential diagnosis and finally findings of our case were most consistent with Wegener's granulomatosis which was confirmed by biopsy and serum testing for anti-neutrophilic cytoplasmic antibodies. Patient was cured with oral prednisolone and cyclophosphamide in the standard dose. After 3 months cyclophosphamide was replaced with myecophenolate moeftil 500 mg BD. At the follow up of 6 months the patient was quiet normal and was relieved of all the symptoms. We feel that the clinicians should be aware of the possible, occurrence of oral lesions of WG and consider them in the differential diagnosis of any oral ulcer of unknown etiology. On further assessment, it is imperative for clinicians to conduct further laboratory and radiographic and histopathological investigations to rule out the disease.