415
FORMAN AND GOLDBERG
4. Reiner DR, Chabner BA, Young RC, et al: Lymphomas presenting in bone: Results of histopathology staging and therapy. Ann Intern Med 87:50, 1977 5. Barker GR: Unifocal lymphomas of the oral cavity. Br J Oral Maxillofacial Surg 22:426, 1984 6. Eisenbud L, Sciubba J: Oral presentations in non-Hodgkin’s lymphoma: A review of thirty-one cases. I. Data analysis. Oral Sure Oral Med Oral Pathol 56: 151. 1983 7. Aozosa K, ?‘sujimoto M, Sukurai M, et al: Non-Hodgkin’s lymphoma in Osaka, Japan. Em J Cancer Clin Oncol 21:487, 1985 8. Freeman C, Berg JW, Cutler SJ: Occurrence and prognosis of extranodal lymphomas. Cancer 29:252. 1972 9. Takahashi H, Tezuka F, Fujita S, et al: Primary extranodal non-Hodgkin’s malignant lymphoma of the oral region: Analvsis of 11 autonsv cases. J Oral Path01 16:241, 1987 10. Slootweg PJ, Wittkampf AR, Kluin PM, et al: Extranodal non-Hodgkin’s lymphoma of the oral tissues. J Maxillofac Surg 13:85, 1985 1I. Tomich CE, Shafer WG: Lymphoproliferative disease of the hard palate. A clinicopathologic entity. Oral Surg 39:754, 1975 12. Fukuda Y, Ishida T, Fujimoto M, et al: Malignant lymphoma of the oral cavity: Clinicopathologic analysis of 20 cases. J Oral Pathol 16:8-12, 1987 13. Haidar Z: A review of non-Hodgkin’s lymphoma of the oral cavity 1950-1980. J Oral Med 41:197, 1986 14. Robbins KT, Fuller LM, Vlasak M, et al: Primary lymphomas of the nasal cavity and paranasal sinuses. Cancer 56:814, 1985 15. Kong JS, Fuller LM, Butler JJ, et al: Stages IE and HE non-Hodgkin’s lymphomas of Waldeyer’s ring and the neck. Am J Clin Oncol 7:629, 1984 16. McGurk M. Goepel JR, Hancock BW: Extranodal lymphoma of the head and neck: A review of 49 consecutive cases. Clin Radio1 36:455. 1985 17. Howell RE, Handlers JP, Abrams AM, et al: Extranodal oral lymphoma. II. Relationships between clinical features and the Lukes-Collins classification of 34 cases. Oral Surg Oral Med Oral Path01 64:597, 1987 18. Batsakis JG: Non-odontogenic tumors of the jaws, in Tu-
J Oral Maxillofac 48:415-419,
19. 20. 21. 22.
23. 24. 25.
26.
27.
28.
29. 30.
31.
32.
33.
mars of the Head and Neck. Baltimore, MD, Williams & Wilkins, 1979, pp 381-419 Wang CC, Fleishil DJ: Primary reticulum cell sarcoma of bone. Cancer 28994, 1%8 Macintyre DR: Lymphomas of the mandible presenting as acute alveolar swellings. Br Dent J 161:25311986 Blake MN. Beck L: Reticulum cell sarcoma: Reoort of a case. J oral Surg 21:165, 1963 Sawyer R, Rosenthal DI, Maniglia AJ, et al: Unusual head and neck manifestations of non-Hodgkin’s lymphomas in children and adults. Laryngoscope 97: 1136, 1987 Slaughter DP, Economou SG, Smith HW: Surgical management of Hodgkin’s disease. Ann Surg 148:705, 1958 Larson DL, Robbins KT, Butler J: Lymphoma of the head and neck: A diagnostic dilemma. Am J Surg 148:433, 1984 Al-Soudani KA, Matukas VJ: Malignant lymphoma of the palate: Report of two cases. J Oral Maxillofac Surg 44:811, 1986 Carbone PP. Kaplan HS, Musshof K, et al: Report of the Committee on Hodgkin’s Disease Staging Classification. Cancer Res 31:1860, 1971 National Cancer Institute: Sponsored study of classifications of non-Hodgkin’s lymphomas: Summary and description of a working formulation for clinical usage. Cancer 49:2112, 1982 Rappaport H: Tumors of the Haematopoetic system. Washington, DC, Armed Forces Institute of Pathology, 1966, pp 91-206 Lukes RJ: The immunologic approach to the pathology of malignant lymphomas. Am J Clin Path01 72:657, 1979 Conley SF, Staszak C, Clamon GH et al: Non-Hodgkin’s lymphoma of the head and neck: The University of Iowa experience. Laryngoscope 97:291, 1987 Shirato H. Tsujii H, Arimoto T, et al: Early stage and neck non-Hodgkin’s lymphoma. The effect of tumor burden on prognosis. Cancer 58:2312, 1986 Lee YY, Van Tassel P, Nauert C, et al: Lymphomas of the head and neck: CT findings at initial presentation. AJR 149:575, 1987 Rusthoven JJ: Current approaches to the treatment of advanced stage non-Hodgkin’s lymphoma. Can Med Assoc J 136:29. 1987
Surg
1990
Microembolization and Resection of a Highly Vascular Pyogenic Granuloma DAVID FORMAN, DDS,* AND HERBERT I. GOLDBERG,
* In private practice, Langhome,
PA.
t Professor of Radiology and Neurosurgery,
Department of of Pennsylvania, Philadel-
Radiology, Hospital of theuniversity phia. Address correspondence and reprint requests to Dr Forman: Oxford Square, 360 Middletown Blvd, Suite 406, Langhome, PA 19047.
0
1990
American Association
geons 0278-2391/90/4804-0016$3.00/O
of Oral
and Maxillofacial
Sur-
MDt
Pyogenic granulomas are common oral lesions that usually present no unusual complications. The pathogenesis of this entity has not been fully understood, and multiple theories have been presented in the literature. The oral pyogenic granuloma is a benign soft tissue growth which can be sessile or pedunculated, and which bleeds readily with minor trauma. This lesion is also known as a pregnancy tumor since it often occurs in pregnant women, and
VASCULAR PYOGENIC GRANULOMA
FIGURE 1. Panoramic radiograph showing the distally displaced second molar extruded from the socket.
it is thought that hormonal changes are responsible for the exaggerated response of tissue to irritation.’ Histologically the lesion is similar to granulation tissue except that it is exuberant and usually well localized. The surface epithelium is generally thin, but may also be hyperplastic. There are a great number of endothelium-lined vascular spaces and proliferation of fibroblasts and endothelial cells, along with infiltration of polymorphonuclear leukocytes, lymphocytes, and plasma cells.3-5 There has been a correlation between the incidence of portwine stain, which is a vascular anomaly that most commonly occurs on the face, and pyogenic granulomas that develop within them.6 Port-wine stains are usually associated with deeper arteriovenous malformations. This report describes a case in which a pyogenic granuloma had extensive arterial feeder vessels.
FIGURE 3.
Nevus on left side of the neck.
extruded approximately 3 mm out of its socket (Figs 1 and 2). The physical examination was significant for multiple port-wine nevi on the left lower lip, ear, chin, and neck which had been present since birth but had increased in
Report of a Case A 30-year-old pregnant exophytic
lesion
woman presented with a 2-cm of the left mandibular body region be-
tween the first and second molars; the second molar was
FIGURE 2. lar.
Exophytic lesion between the first and second moFIGURE 4.
Nevus on left side of the lower lip.
FORMAN
417
AND GOLDBERG
color and intensity during pregnancy (Figs 3 and 4). An unusual amount of hemorrhage occurred during an incisional biopsv performed with local anesthesia. This was controlled with electrocautery and pressure after approximately 30 minutes. Periodic oozing of blood occurred for approximately 1 week. The lesion was diagnosed histologically as B pyogenic granuloma.
Following the patient’s pregnancy, a left external carotid arteriogram was performed to determine the vascular supply to the lesion, which continued to grow rapidly. Prominent feeding vessels arising from the inferior alveolar branch of the left maxillary artery were present, which supplied a tumor stain on the gingival surface (Fig 5A). In view of the bleeding that occurred during biopsy, it was felt that in order to decrease the morbidity of definitive surgical removal, microembolization of the vascular supply would be beneficial. Microembolization of the left inferior alveolar artery was performed using 149to 250-km-sized particles of polyvinyl alcohol foam (Fig 5B). The patient recovered without incident from the embolization, and 2 weeks later in the operating room underwent extraction of the second molar and resection of the pyogenic granuloma and surrounding alveolar bone. The blood loss was approximately 25 mL, and healing occurred without complications. The patient has been followed for 1 year without recurrence.
sion, but a tendency towards recurrence exists (16%).’ Clinically, these lesions are elevated, pedunculated or sessile masses that bleed readily. No pus is present within the lesion unless it is secondarily infected. The site of frequency in the oral cavity in decreasing order is the gingiva, lips, tongue, buccal mucosa, palate, and mucolabial fold. The hormonal imbalance during pregnancy is thought to result in the gingival response to local irritation. The resulting hyperplastic lesion of the pregnancy tumor is identical to a pyogenic granuloma, but it differs in that removal of irritants and termination of pregnancy result in regression of the lesion without surgery.‘*2 Pyogenic granulomas have been known also to arise within port-wine stains, and this case helps to support the postulation that arteriovenous anastomoses are associated with the pathogenesis of some pyogenic granulomas.6*7 In this case port-wine nevi were present on the left side of the face and adjacent to the pyogenic granuloma.
Discussion
Summary
Oral pyogenic granuloma has been described as a benign reactive gingival lesion that is very common during pregnancy. Treatment has been local exci-
An unusual case is reported of a hypervascular pyogenic granuloma arising from the mandible which continued to grow postpartum in a person
FIGURE 5. Preembolization and postembolization lateral digital substraction arteriograms of the left external carotid artery. A, Preembolization: enlarged gingival alveolar branches (arrowheads) of the inferior alveolar artery supply a tumor stain on the gingival surface (arrow). B, Postembolization arteriogram demonstrates obliteration of multiple terminal branches of the inferior alveolar artery and no tumor stain.
418
ERYTHEMA INFECTIOSLJM-THE
with an associated port-wine nevus. Microembolization of the lesions permitted complete surgical removal with minimal blood loss. This case supports the theory of arteriovenous anastomosis being associated with the pathogenesis of pyogenic granulomas .
3. 4. 5. 6.
References
7. 1. Moriconi SE, Popowich LD: Alveolar pyogenic granuloma: Review and report of a case. Laryngoscope 94:807, 1984 2. Bhaskar SM. Jacoway, JR: Pyogenic granuloma clinical fea-
J Oral Maxillofac 49:419-419.
FIFTH DISEASE
tures, incidence, histology and results of treatment: Report of 242 cases. J Oral Surg 24:391, 1966 Eversole LS, Rovin S: Reactive lesions of the gingiva. Oral Surg 1:30, 1972 Leyden JJ, Mater GH: Oral cavity pyogenic granuloma. Arch Dermato126: 131, 1932 Wood NK, Goaz PW: Differential Diagnosis of Oral Lesions (ed 2). St Louis, MO, Mosby, 1980, pp 129-30 Swerlick RA, Cooper DH: Pyogenic granuloma (lobular capillary hemangioma) within port-wine stains. J Am Acad Dermatol8:627, 1983 Mills SE, Cooper PH, Fechner RE: Lobular capillary hemangioma: The underlying lesion of pyogenic granuloma. A study of 73 cases from oral and nasal mucous membranes. Am J Surg Path01 4:471, 1980
Surg
1990
Erythema Infectiosum-The
Fifth Disease:
Case Report HARRY DYM, DDS
Erythema infectiosum, a moderately contagious exanthematous disease affecting mainly children, is frequently called The Fifth Disease because it was the fifth of five illnesses described exhibiting somewhat similar rashes. ’ The other four diseases were rubella, measles, scarlet fever, and Filatou-Dukes disease (the last is now thought to be a mild atypical form of scarlet fever). The first recognized outbreak of this disease occurred in Germany and was described in 1889 by Tschammer,* who considered it a form of rubella. In 1899, Stricker3 described another epidemic and gave the disease its present name erythema infectiosum. It has been reported since in many other parts of the world, including the United States. This disease should be of interest to the oral and maxillofacial surgeon because its first presenting sign is a malar rash with no other prodromal symptoms. This article presents a case report of erythema infectiosum and a discussion of its clinical findings. * Assistant Director, Department of Dentistry, Woodhull Medical and Mental Health Center; Associate Director of Oral and Maxillofacial Surgery, The Brooklyn-Caledonian Hospital, Brooklyn, NY. Address correspondence and reprint requests to Dr Dym: Department of Oral and Maxillofacial Surgery, The BrooklynCaledonian Hospital, 121 DeKalb Ave, Brooklyn, NY 11201. 0 1990 American geons
Association
0278-2391/90/4804-0017$3.0010
of Oral and Maxillofacial
Sur-
Report of a Case In May 1987, a 6-year-old white girl was brought to the clinic because of a rash that suddenly appeared on the child’s cheeks. The patient’s past medical history was noncontributory. She was afebrile and stated she felt well. Head and neck examination showed a very bright exanthematous rash confined to the cheeks that was warm to touch but not tender (Fig 1). No lymphadenopathy was present and no significant oral findings were noted. The patient’s mother was advised to return the child the next day for follow-up. Upon return it was noted that her upper and lower extremities were covered with a maculopapular lacy rash (Fig 2). The patient’s pediatrician was consulted and a diagnosis of erythema infectiosum was made.
Discussion The cause of erythema infectiosum has only recently been shown to be viral. Anderson et al4 in 1984 investigated an extensive outbreak of the disease in a London primary school and reported good evidence to implicate the human parvovirus. Virologic and serologic studies of 36 typical cases of the disease revealed the presence of parvovirusspecific IgM antibody. There is no sex predilection, and infants and adults are rarely affected. The peak incidence is at age 7 years5 and most outbreaks occur in late winter and spring. The mechanism of transmission is unclear. Histologic study of skin biopsy specimens reveals a perivascular lymphocytic infiltration with edema of the dermis.
FORMAN AND GOLDBERG
4. Reiner DR, Chabner BA, Young RC, et al: Lymphomas presenting in bone: Results of histopathology staging and therapy. Ann Intern Med 87:50, 1977 5. Barker GR: Unifocal lymphomas of the oral cavity. Br J Oral Maxillofacial Surg 22:426, 1984 6. Eisenbud L, Sciubba J: Oral presentations in non-Hodgkin’s lymphoma: A review of thirty-one cases. I. Data analysis. Oral Sure Oral Med Oral Pathol 56: 151. 1983 7. Aozosa K, ?‘sujimoto M, Sukurai M, et al: Non-Hodgkin’s lymphoma in Osaka, Japan. Em J Cancer Clin Oncol 21:487, 1985 8. Freeman C, Berg JW, Cutler SJ: Occurrence and prognosis of extranodal lymphomas. Cancer 29:252. 1972 9. Takahashi H, Tezuka F, Fujita S, et al: Primary extranodal non-Hodgkin’s malignant lymphoma of the oral region: Analvsis of 11 autonsv cases. J Oral Path01 16:241, 1987 10. Slootweg PJ, Wittkampf AR, Kluin PM, et al: Extranodal non-Hodgkin’s lymphoma of the oral tissues. J Maxillofac Surg 13:85, 1985 1I. Tomich CE, Shafer WG: Lymphoproliferative disease of the hard palate. A clinicopathologic entity. Oral Surg 39:754, 1975 12. Fukuda Y, Ishida T, Fujimoto M, et al: Malignant lymphoma of the oral cavity: Clinicopathologic analysis of 20 cases. J Oral Pathol 16:8-12, 1987 13. Haidar Z: A review of non-Hodgkin’s lymphoma of the oral cavity 1950-1980. J Oral Med 41:197, 1986 14. Robbins KT, Fuller LM, Vlasak M, et al: Primary lymphomas of the nasal cavity and paranasal sinuses. Cancer 56:814, 1985 15. Kong JS, Fuller LM, Butler JJ, et al: Stages IE and HE non-Hodgkin’s lymphomas of Waldeyer’s ring and the neck. Am J Clin Oncol 7:629, 1984 16. McGurk M. Goepel JR, Hancock BW: Extranodal lymphoma of the head and neck: A review of 49 consecutive cases. Clin Radio1 36:455. 1985 17. Howell RE, Handlers JP, Abrams AM, et al: Extranodal oral lymphoma. II. Relationships between clinical features and the Lukes-Collins classification of 34 cases. Oral Surg Oral Med Oral Path01 64:597, 1987 18. Batsakis JG: Non-odontogenic tumors of the jaws, in Tu-
J Oral Maxillofac 48:415-419,
19. 20. 21. 22.
23. 24. 25.
26.
27.
28.
29. 30.
31.
32.
33.
mars of the Head and Neck. Baltimore, MD, Williams & Wilkins, 1979, pp 381-419 Wang CC, Fleishil DJ: Primary reticulum cell sarcoma of bone. Cancer 28994, 1%8 Macintyre DR: Lymphomas of the mandible presenting as acute alveolar swellings. Br Dent J 161:25311986 Blake MN. Beck L: Reticulum cell sarcoma: Reoort of a case. J oral Surg 21:165, 1963 Sawyer R, Rosenthal DI, Maniglia AJ, et al: Unusual head and neck manifestations of non-Hodgkin’s lymphomas in children and adults. Laryngoscope 97: 1136, 1987 Slaughter DP, Economou SG, Smith HW: Surgical management of Hodgkin’s disease. Ann Surg 148:705, 1958 Larson DL, Robbins KT, Butler J: Lymphoma of the head and neck: A diagnostic dilemma. Am J Surg 148:433, 1984 Al-Soudani KA, Matukas VJ: Malignant lymphoma of the palate: Report of two cases. J Oral Maxillofac Surg 44:811, 1986 Carbone PP. Kaplan HS, Musshof K, et al: Report of the Committee on Hodgkin’s Disease Staging Classification. Cancer Res 31:1860, 1971 National Cancer Institute: Sponsored study of classifications of non-Hodgkin’s lymphomas: Summary and description of a working formulation for clinical usage. Cancer 49:2112, 1982 Rappaport H: Tumors of the Haematopoetic system. Washington, DC, Armed Forces Institute of Pathology, 1966, pp 91-206 Lukes RJ: The immunologic approach to the pathology of malignant lymphomas. Am J Clin Path01 72:657, 1979 Conley SF, Staszak C, Clamon GH et al: Non-Hodgkin’s lymphoma of the head and neck: The University of Iowa experience. Laryngoscope 97:291, 1987 Shirato H. Tsujii H, Arimoto T, et al: Early stage and neck non-Hodgkin’s lymphoma. The effect of tumor burden on prognosis. Cancer 58:2312, 1986 Lee YY, Van Tassel P, Nauert C, et al: Lymphomas of the head and neck: CT findings at initial presentation. AJR 149:575, 1987 Rusthoven JJ: Current approaches to the treatment of advanced stage non-Hodgkin’s lymphoma. Can Med Assoc J 136:29. 1987
Surg
1990
Microembolization and Resection of a Highly Vascular Pyogenic Granuloma DAVID FORMAN, DDS,* AND HERBERT I. GOLDBERG,
* In private practice, Langhome,
PA.
t Professor of Radiology and Neurosurgery,
Department of of Pennsylvania, Philadel-
Radiology, Hospital of theuniversity phia. Address correspondence and reprint requests to Dr Forman: Oxford Square, 360 Middletown Blvd, Suite 406, Langhome, PA 19047.
0
1990
American Association
geons 0278-2391/90/4804-0016$3.00/O
of Oral
and Maxillofacial
Sur-
MDt
Pyogenic granulomas are common oral lesions that usually present no unusual complications. The pathogenesis of this entity has not been fully understood, and multiple theories have been presented in the literature. The oral pyogenic granuloma is a benign soft tissue growth which can be sessile or pedunculated, and which bleeds readily with minor trauma. This lesion is also known as a pregnancy tumor since it often occurs in pregnant women, and
VASCULAR PYOGENIC GRANULOMA
FIGURE 1. Panoramic radiograph showing the distally displaced second molar extruded from the socket.
it is thought that hormonal changes are responsible for the exaggerated response of tissue to irritation.’ Histologically the lesion is similar to granulation tissue except that it is exuberant and usually well localized. The surface epithelium is generally thin, but may also be hyperplastic. There are a great number of endothelium-lined vascular spaces and proliferation of fibroblasts and endothelial cells, along with infiltration of polymorphonuclear leukocytes, lymphocytes, and plasma cells.3-5 There has been a correlation between the incidence of portwine stain, which is a vascular anomaly that most commonly occurs on the face, and pyogenic granulomas that develop within them.6 Port-wine stains are usually associated with deeper arteriovenous malformations. This report describes a case in which a pyogenic granuloma had extensive arterial feeder vessels.
FIGURE 3.
Nevus on left side of the neck.
extruded approximately 3 mm out of its socket (Figs 1 and 2). The physical examination was significant for multiple port-wine nevi on the left lower lip, ear, chin, and neck which had been present since birth but had increased in
Report of a Case A 30-year-old pregnant exophytic
lesion
woman presented with a 2-cm of the left mandibular body region be-
tween the first and second molars; the second molar was
FIGURE 2. lar.
Exophytic lesion between the first and second moFIGURE 4.
Nevus on left side of the lower lip.
FORMAN
417
AND GOLDBERG
color and intensity during pregnancy (Figs 3 and 4). An unusual amount of hemorrhage occurred during an incisional biopsv performed with local anesthesia. This was controlled with electrocautery and pressure after approximately 30 minutes. Periodic oozing of blood occurred for approximately 1 week. The lesion was diagnosed histologically as B pyogenic granuloma.
Following the patient’s pregnancy, a left external carotid arteriogram was performed to determine the vascular supply to the lesion, which continued to grow rapidly. Prominent feeding vessels arising from the inferior alveolar branch of the left maxillary artery were present, which supplied a tumor stain on the gingival surface (Fig 5A). In view of the bleeding that occurred during biopsy, it was felt that in order to decrease the morbidity of definitive surgical removal, microembolization of the vascular supply would be beneficial. Microembolization of the left inferior alveolar artery was performed using 149to 250-km-sized particles of polyvinyl alcohol foam (Fig 5B). The patient recovered without incident from the embolization, and 2 weeks later in the operating room underwent extraction of the second molar and resection of the pyogenic granuloma and surrounding alveolar bone. The blood loss was approximately 25 mL, and healing occurred without complications. The patient has been followed for 1 year without recurrence.
sion, but a tendency towards recurrence exists (16%).’ Clinically, these lesions are elevated, pedunculated or sessile masses that bleed readily. No pus is present within the lesion unless it is secondarily infected. The site of frequency in the oral cavity in decreasing order is the gingiva, lips, tongue, buccal mucosa, palate, and mucolabial fold. The hormonal imbalance during pregnancy is thought to result in the gingival response to local irritation. The resulting hyperplastic lesion of the pregnancy tumor is identical to a pyogenic granuloma, but it differs in that removal of irritants and termination of pregnancy result in regression of the lesion without surgery.‘*2 Pyogenic granulomas have been known also to arise within port-wine stains, and this case helps to support the postulation that arteriovenous anastomoses are associated with the pathogenesis of some pyogenic granulomas.6*7 In this case port-wine nevi were present on the left side of the face and adjacent to the pyogenic granuloma.
Discussion
Summary
Oral pyogenic granuloma has been described as a benign reactive gingival lesion that is very common during pregnancy. Treatment has been local exci-
An unusual case is reported of a hypervascular pyogenic granuloma arising from the mandible which continued to grow postpartum in a person
FIGURE 5. Preembolization and postembolization lateral digital substraction arteriograms of the left external carotid artery. A, Preembolization: enlarged gingival alveolar branches (arrowheads) of the inferior alveolar artery supply a tumor stain on the gingival surface (arrow). B, Postembolization arteriogram demonstrates obliteration of multiple terminal branches of the inferior alveolar artery and no tumor stain.
418
ERYTHEMA INFECTIOSLJM-THE
with an associated port-wine nevus. Microembolization of the lesions permitted complete surgical removal with minimal blood loss. This case supports the theory of arteriovenous anastomosis being associated with the pathogenesis of pyogenic granulomas .
3. 4. 5. 6.
References
7. 1. Moriconi SE, Popowich LD: Alveolar pyogenic granuloma: Review and report of a case. Laryngoscope 94:807, 1984 2. Bhaskar SM. Jacoway, JR: Pyogenic granuloma clinical fea-
J Oral Maxillofac 49:419-419.
FIFTH DISEASE
tures, incidence, histology and results of treatment: Report of 242 cases. J Oral Surg 24:391, 1966 Eversole LS, Rovin S: Reactive lesions of the gingiva. Oral Surg 1:30, 1972 Leyden JJ, Mater GH: Oral cavity pyogenic granuloma. Arch Dermato126: 131, 1932 Wood NK, Goaz PW: Differential Diagnosis of Oral Lesions (ed 2). St Louis, MO, Mosby, 1980, pp 129-30 Swerlick RA, Cooper DH: Pyogenic granuloma (lobular capillary hemangioma) within port-wine stains. J Am Acad Dermatol8:627, 1983 Mills SE, Cooper PH, Fechner RE: Lobular capillary hemangioma: The underlying lesion of pyogenic granuloma. A study of 73 cases from oral and nasal mucous membranes. Am J Surg Path01 4:471, 1980
Surg
1990
Erythema Infectiosum-The
Fifth Disease:
Case Report HARRY DYM, DDS
Erythema infectiosum, a moderately contagious exanthematous disease affecting mainly children, is frequently called The Fifth Disease because it was the fifth of five illnesses described exhibiting somewhat similar rashes. ’ The other four diseases were rubella, measles, scarlet fever, and Filatou-Dukes disease (the last is now thought to be a mild atypical form of scarlet fever). The first recognized outbreak of this disease occurred in Germany and was described in 1889 by Tschammer,* who considered it a form of rubella. In 1899, Stricker3 described another epidemic and gave the disease its present name erythema infectiosum. It has been reported since in many other parts of the world, including the United States. This disease should be of interest to the oral and maxillofacial surgeon because its first presenting sign is a malar rash with no other prodromal symptoms. This article presents a case report of erythema infectiosum and a discussion of its clinical findings. * Assistant Director, Department of Dentistry, Woodhull Medical and Mental Health Center; Associate Director of Oral and Maxillofacial Surgery, The Brooklyn-Caledonian Hospital, Brooklyn, NY. Address correspondence and reprint requests to Dr Dym: Department of Oral and Maxillofacial Surgery, The BrooklynCaledonian Hospital, 121 DeKalb Ave, Brooklyn, NY 11201. 0 1990 American geons
Association
0278-2391/90/4804-0017$3.0010
of Oral and Maxillofacial
Sur-
Report of a Case In May 1987, a 6-year-old white girl was brought to the clinic because of a rash that suddenly appeared on the child’s cheeks. The patient’s past medical history was noncontributory. She was afebrile and stated she felt well. Head and neck examination showed a very bright exanthematous rash confined to the cheeks that was warm to touch but not tender (Fig 1). No lymphadenopathy was present and no significant oral findings were noted. The patient’s mother was advised to return the child the next day for follow-up. Upon return it was noted that her upper and lower extremities were covered with a maculopapular lacy rash (Fig 2). The patient’s pediatrician was consulted and a diagnosis of erythema infectiosum was made.
Discussion The cause of erythema infectiosum has only recently been shown to be viral. Anderson et al4 in 1984 investigated an extensive outbreak of the disease in a London primary school and reported good evidence to implicate the human parvovirus. Virologic and serologic studies of 36 typical cases of the disease revealed the presence of parvovirusspecific IgM antibody. There is no sex predilection, and infants and adults are rarely affected. The peak incidence is at age 7 years5 and most outbreaks occur in late winter and spring. The mechanism of transmission is unclear. Histologic study of skin biopsy specimens reveals a perivascular lymphocytic infiltration with edema of the dermis.
