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ID 116161
Title Alternative
Oral granuloma with chronic graft-vs-host disease
Author
Tsushima, Fumihiko Tokyo Medical and Dental University
Kodama, Makoto Tokyo Medical and Dental University
Kuroshima, Takeshi Tokyo Medical and Dental University
Sakurai, Jinkyo Tokyo Medical and Dental University
Harada, Hiroyuki Tokyo Medical and Dental University
Keywords
Oral granuloma
Graft-versus-host disease
Bone marrow transplantation
Primary immunodeficiency disease
Tacrolimus
Case report
Content Type
Journal Article
Description
BACKGROUND
Oral mucositis is often observed with graft-versus-host disease (GVHD); however, the occurrence of oral granuloma is rare. The rapid increase in granulomatous lesions should be distinguished from malignant tumors in patients with GVHD because malignant diseases can develop in those patients. This case is the youngest pediatric patient with granuloma associated with GVHD.

CASE SUMMARY
The patient was a 1-year and 5-mo-old girl who presented to our department for the management of oral nodules. At the age of 5 mo, she was diagnosed with primary immunodeficiency disease, cord blood transplant was performed at 11 mo and bone marrow transplant at 1 year of age. After transplantation, GVHD and oral mucositis developed, and tacrolimus was administered. Interestingly, nodules appeared on the lower lip and buccal mucosa, which spontaneously disappeared. Then, a new nodule appeared on the left lateral border of the tongue. Resection was performed and the histopathological diagnosis was granuloma. The origin of these nodules were considered to be the fibroblasts activated under inflammation caused by GVHD because the calcineurin inhibitor tacrolimus acted on their proliferation.

CONCLUSION
It is very important to distinguish oral granulomatous lesions from malignancies if GVHD is present at the base and if immunosuppressive agents and steroids are being administered.
Journal Title
World Journal of Clinical Cases
ISSN
23078960
Publisher
Baishideng Publishing Group
Volume
8
Issue
22
Start Page
5663
End Page
5669
Published Date
2020-11-26
Rights
This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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DOI (Published Version)
URL ( Publisher's Version )
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language
eng
TextVersion
Publisher
departments
Oral Sciences