Idiopathic orofacial granulomatosis in a pediatric patient: A case report

Abstract

Idiopathic orofacial granulomatosis (OFG) is a rare granulomatous disorder with variable oral manifestations. In children, recurrent gingival enlargement as the predominant manifestation can present a diagnostic challenge and requires careful histopathological and systemic evaluation. This case report presents an 11-year-old boy with recurrent diffuse gingival enlargement, gingival bleeding and difficulty in chewing. The gingival enlargement had recurred following previous surgical excision and was associated with increased probing depths but no evident alveolar bone loss. There was no history of food, medication or cosmetic allergy or relevant systemic illness. Histopathological examination showed nonnecrotizing epithelioid granulomas, multinucleated giant cells and chronic inflammatory infiltrate. A complete work-up for secondary causes, including tuberculosis, sarcoidosis and Crohn’s disease, was unremarkable, with no evidence of systemic disease, supporting a diagnosis of idiopathic OFG. Initial phase I periodontal therapy produced no appreciable improvement, following which the patient underwent full-mouth gingivectomy and gingivoplasty using electrocautery. The patient showed marked clinical improvement and remained asymptomatic without recurrence during 1 year of followup. This case highlights the importance of early recognition, biopsy and systematic evaluation for underlying systemic disease in children presenting with recurrent gingival enlargement and emphasizes the role of individualized management and long-term follow-up in idiopathic OFG.