Früherkennung von Morbus Crohn anhand von oralen Manifestationen bei einer Patientin mit Marfan-Syndrom

Zusammenfassung

Ziel Dieser Fallbericht zeigt eine Patientin mit der Anamnese des Marfan-Syndroms (MFS) und einer atypischen gingivalen Hyperplasie, die zu einer frühen Diagnose von Morbus Crohn führte.

Material und Methoden Die Patientin zeigte typische kraniofaziale Manifestationen des Marfan-Syndroms. Zusätzlich stellte sich eine zunächst einseitige, dann symmetrische atypische Gingivahyperplasie im Frontzahnbereich dar. Die antiinfektiöse Parodontaltherapie verbesserte den überlagerten entzündlichen Teil des hyperplastischen Parodonts, aber die Hyperplasie blieb zu einem großen Teil bestehen.

Ergebnisse Die vermutete frühe Manifestation des Morbus Crohn im Oralbereich wurde histologisch durch eine Biopsie bestätigt. Morbus Crohn wurde anschließend durch eine internistische Endoskopie verifiziert.

Fazit Das Durchschnittsalter der Patienten, die sich einer kieferorthopädischen Behandlung unterziehen, entspricht dem Alter, in dem sich systemische Erkrankungen oft zum ersten Mal manifestieren. Orale Symptome können die ersten Anzeichen einer systemischen Erkrankung sein, wie in diesem Fall Morbus Crohn, und bieten somit die Möglichkeit zur Früherkennung durch Kieferorthopäden und Allgemeinzahnärzte.

Abstract

Aim This case report presents a female patient with an anamnestic history of Marfan syndrome (MFS) and an atypical gingival hyperplasia which lead to an early diagnosis of Morbus Crohn.

Material and Methods The patient showed typical craniofacial manifestations of Marfan syndrome. In addition she presented an initially unilateral, then symmetrical atypical gingival hyperplasia in the anterior region. The anti-infective periodontal therapy improved the superimposed inflammatory part of the hyperplastic gingival condition, but a substantial amount of hyperplasia persisted.

Results The suspected early manifestation of oral Crohn's disease was histologically confirmed by a biopsy. Morbus Crohn was subsequently confirmed by an internistic endoscopy.

Conclusion The average age of patients in orthodontics corresponds to the age in which systemic diseases often manifest themselves for the first time. Oral symptoms can be the first signs of systemic disease, such as in this case Crohn's disease, and as such offer the possibility for early diagnosis by orthodontists and general dentists.

Schlüsselwörter

Morbus Crohn - orale Manifestationen - Marfan-Syndrom

Key words

Crohn’s disease - oral manifestations - Marfan syndrome

^* contributed equally to senior authorship

• Literatur

• 1 Crohn BB, Ginzburg L, Oppenheimer GD. Landmark article Oct 15, 1932. Regional ileitis. A pathological and clinical entity. By Burril B. Crohn, Leon Ginzburg, and Gordon D. Oppenheimer. JAMA 1984; 251: 73-79
• 2 Tyldesley WR. Oral Crohn̓s disease and related conditions. Br J Oral Surg 1979; 17: 1-9
• 3 Greenstein AJ, Janowitz HD, Sachar DB. The extra-intestinal complications of Crohn̓s disease and ulcerative colitis: a study of 700 patients. Medicine (Baltimore) 1976; 55: 401-412
• 4 Shivananda S, Lennard-Jones J, Logan R. et al. Incidence of inflammatory bowel disease across Europe: Is there a difference between north and south? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Gut 1996; 39: 690-697
• 5 Stavropoulos F, Katz J, Guelmann M. et al. Oral ulcerations as a sign of Crohn̓s disease in a pediatric patient: A case report. Pediatr Dent 2004; 26: 355-358
• 6 Dudeney TP. Crohn̓s disease of the mouth. Proc R Soc Med 1969; 62: 1237
• 7 Coenen C, Börsch G, Müller KM. et al. Oral inflammatory changes as an initial manifestation of Crohn̓s disease antedating abdominal diagnosis. Report of a case. Dis Colon Rectum 1988; 31: 548-552
• 8 Dunlap CL, Friesen CA, Shultz R. Chronic stomatitis: an early sign of Crohn̓s disease. J Am Dent Assoc 1997; 128: 347-348
• 9 Rehberger A, Püspök A, Stallmeister T. et al. Crohn̓s disease masquerading as aphthous ulcers. Eur J Dermatol 1998; 8: 274-276
• 10 Varley EW. Crohn̓s disease of the mouth. Report of three cases. Oral Surg Oral Med Oral Pathol 1972; 33: 570-578
• 11 Bishop RP, Brewster AC, Antonioli DA. Crohn̓s disease of the mouth. Gastroenterology 1972; 62: 302-306
• 12 Bottomley WK, Giorgini GL, Julienne CH. Oral extension of regional enteritis (Crohn̓s disease). Report of a case. Oral Surg Oral Med Oral Pathol 1972; 34: 417-420
• 13 Eisenbud L, Katzka I, Platt N. Oral manifestations in Crohn̓s disease. Report of a case. Oral Surg Oral Med Oral Pathol 1972; 34: 770-773
• 14 Ellis JP. Crohn̓s disease with mouth involvement. Proc R Soc Med 1972; 65: 1080
• 15 Michailidou E, Arvanitidou S, Lombardi T. et al. Oral lesions leading to the diagnosis of Crohn disease: report on 5 patients. Quintessence Int 2009; 40: 581-588
• 16 Muhvić-Urek M, Tomac-Stojmenović M, Mijandrušić-Sinšić B. Oral pathology in inflammatory bowel disease. World J Gastroenterol 2016; 22: 5655-5667
• 17 Padmavathi B, Sharma S, Astekar M. et al. Oral Crohn̓s disease. J Oral Maxillofac Pathol 2014; 18 (Suppl. 01) S139-S142
• 18 Verbov J. Crohn̓s disease with mouth and lip involvement. Br J Dermatol 1973; 88: 517
• 19 Skrzat A, Olczak-Kowalczyk D, Turska-Szybka A. Crohn̓s disease should be considered in children with inflammatory oral lesions. Acta Paediatr 2017; 106: 199-203
• 20 Gray JR, Davies SJ. Marfan syndrome. J Med Genet 1996; 33: 403-408
• 21 McKusick VA. Heritable disorders of connective tissue. III. The Marfan syndrome. J Chronic Dis 1955; 2: 609-644
• 22 De Paepe A, Devereux RB, Dietz HC. et al. Revised diagnostic criteria for the Marfan syndrome. Am J Med Genet 1996; 62: 417-426
• 23 Bauss O, Sadat-Khonsari R, Fenske C. et al. Temporomandibular joint dysfunction in Marfan syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97: 592-598
• 24 Bauss O, Neter D, Rahman A. Prevalence of pulp calcifications in patients with Marfan syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106: e56-e61
• 25 Crosher R, Holmes A. Marfan syndrome: Dental problems and management. Dent Update 1988; 15: 120 122
• 26 De Coster PJ, Martens LC, De Paepe A. Oral manifestations of patients with Marfan syndrome: A case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93: 564-572
• 27 De Coster PJ, Martens LC, De Paepe A. Orofacial manifestations of congenital fibrillin deficiency: Pathogenesis and clinical diagnostics. Pediatr Dent 2004; 26: 535-537
• 28 Khonsari RH, Corre P, Boukerma-Vernex Z. et al. Extreme oral manifestations in a Marfan-type syndrome. Int J Oral Maxillofac Surg 2010; 39: 622-625
• 29 Utreja A, Evans CA. Marfan syndrome – an orthodontic perspective. Angle Orthod 2009; 79: 394-400
• 30 Westling L, Mohlin B, Bresin A. Craniofacial manifestations in the Marfan syndrome: palatal dimensions and a comparative cephalometric analysis. J Craniofac Genet Dev Biol 1998; 18: 211-218
• 31 Gagnier JJ, Kienle G, Altman DG. et al. The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development. Glob Adv Health Med 2013; 2: 38-43
• 32 Spehlmann ME, Begun AZ, Burghardt J. et al. Epidemiology of inflammatory bowel disease in a German twin cohort: Results of a nationwide study. Inflamm Bowel Dis 2008; 14: 968-976
• 33 Yamamoto-Furusho JK, Korzenik JR. Crohn̓s disease: Innate immunodeficiency?. World J Gastroenterol 2006; 12: 6751-6755
• 34 Schreiber S, Rosenstiel P, Albrecht M. et al. Genetics of Crohn disease, an archetypal inflammatory barrier disease. Nat Rev Genet 2005; 6: 376-388
• 35 Galbraith SS, Drolet BA, Kugathasan S. et al. Asymptomatic inflammatory bowel disease presenting with mucocutaneous findings. Pediatrics 2005; 116: e439-e444
• 36 Suda N, Shiga M, Ganburged G. et al. Marfan syndrome and its disorder in periodontal tissues. J Exp Zool B Mol Dev Evol 2009; 312B: 503-509
• 37 Suzuki JI, Imai Y, Aoki M. et al. High incidence and severity of periodontitis in patients with Marfan syndrome in Japan. Heart Vessels 2015; 30: 692-695
• 38 Papageorgiou SN, Hagner M, Nogueira AV. et al. Inflammatory bowel disease and oral health: systematic review and a meta-analysis. J Clin Periodontol 2017; 44: 382-393
• 39 Staufenbiel I, Hauschild C, Kahl-Nieke B. et al. Periodontal conditions in patients with Marfan syndrome – a multicenter case control study. BMC Oral Health 2013; 13: 59
• 40 Chi AC, Neville BW, Krayer JW. et al. Oral manifestations of systemic disease. Am Fam Physician 2010; 82: 1381-1388
• 41 Ruocco E, Cuomo A, Salerno R. et al. Crohn̓s disease and its mucocutaneous involvement. Skinmed 2007; 6: 179-185