Plasma cell mucositis with gingival enlargement and severe periodontitis

Summary of article contents:

Introduction

Plasma cell mucositis (PCM) is a rare, chronic, multifocal, idiopathic non-neoplastic plasma cell proliferative disorder affecting the upper aerodigestive tract. The condition typically presents with an intensely erythematous mucosa and various surface changes such as papillomatous or cobblestone textures. With fewer than 50 cases reported in medical literature, PCM poses unique diagnostic challenges as it closely resembles other benign and neoplastic conditions of the oral cavity. The diagnosis requires exclusion of various infectious, autoimmune, allergic, and reactive disorders that may exhibit plasma cell infiltrates.

Diagnosis and Treatment Challenges

PCM was diagnosed in a 72-year-old male patient who presented with symptoms including oral ulcers, gingival enlargement, and dysphagia. Histopathological examination of the affected tissue revealed a hyperplastic epithelium with a dense infiltrate of mature polyclonal plasma cells in the lamina propria, confirming the diagnosis of PCM. The treatment options for PCM are predominantly symptomatic, with corticosteroids being the most commonly employed form of therapy. Despite initial corticosteroid treatments leading to some improvement, the patient experienced relapses and did not achieve sustained remission. Other treatment modalities, including immunosuppressants and surgical interventions, have shown limited success, underscoring the need for ongoing management strategies tailored to individual cases.

Conclusion

PCM is a complex condition with unknown etiology that likely arises from unidentified environmental antigens or hypersensitivity reactions. The ongoing management of PCM demands careful considerations given the patient’s overall health and the implications of long-term corticosteroid use, which can lead to significant complications. Although the condition is classified as benign, the chronic nature of PCM and recent reports of malignant transformation necessitate comprehensive follow-up and exploration of novel therapeutic strategies to better address this debilitating disorder. Further research into the pathophysiology and potential targeted treatments could offer new hope for patients suffering from PCM.