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"documento" => "article" "crossmark" => 0 "subdocumento" => "ssu" "cita" => "Acta Otorrinolaringol Esp. 2014;65:47-52" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2234 "formatos" => array:3 [ "EPUB" => 28 "HTML" => 1332 "PDF" => 874 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review Article</span>" "titulo" => "Biofilms in Otolaryngology" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "47" "paginaFinal" => "52" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Biofilms</span> en otorrinolaringología" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nicolás Mena Viveros" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Nicolás" "apellidos" => "Mena Viveros" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000165191200204X" "doi" => "10.1016/j.otorri.2012.08.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000165191200204X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573514000088?idApp=UINPBA00004N" "url" => "/21735735/0000006500000001/v1_201403140154/S2173573514000088/v1_201403140154/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Study</span>" "titulo" => "Wegener's Granulomatosis With Oral Mucosal Involvement as First Manifestation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "53" "paginaFinal" => "55" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alberto Candau, Borja Valenzuela, Alicia Dean, Francisco J. Alamillos" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Alberto" "apellidos" => "Candau" "email" => array:1 [ 0 => "dr.candaualvarez@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Borja" "apellidos" => "Valenzuela" ] 2 => array:2 [ "nombre" => "Alicia" "apellidos" => "Dean" ] 3 => array:2 [ "nombre" => "Francisco J." "apellidos" => "Alamillos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Oral y Maxilofacial, Hospital Universitario Reina Sofía, Córdoba, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Granulomatosis de Wegener con afectación de la mucosa oral como primera manifestación" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 550 "Ancho" => 1000 "Tamanyo" => 114015 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mucosal gingival lesions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Wegener's granulomatosis (WG) is an autoimmune disease, which particularly affects the upper respiratory pathways, lungs and kidney. Oral mucosal involvement presents in around 5%–10%<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> of cases and may be the first disease symptom. Predominant manifestation is granulomatous gingivitis erythematous papules<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>; mucosal necrosis and non-specific ulcers with or without impact on adjacent structures. Clinically speaking, the most characteristic lesion presents as a gingival hyperplasia of the gum, with hyperaemia and petechias on its surface which bleed when touched. Due to its appearance, it has been called “Strawberry gingiva”.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> The following is a clinical case in which the granulomatous strawberry gingivitis was the first sign of WG.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Clinical Case</span><p id="par0010" class="elsevierStylePara elsevierViewall">A gypsy woman aged 44 was referred from another hospital's A&E department following examination by an otolaryngologist, after presentation with a two-month history of pain and swelling across the upper right dental arch, accompanied by fever during the previous 2 weeks. Prior to this period, a dental implant in the upper right premolar with no prosthesis had been fitted. Medical treatment had been received with diverse antibiotics and mouthwashes but no improvement had been made.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Anamnesis was with no findings of interest. She was on occasional smoker of less than half a packet of cigarettes per day.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Granular and friable gingival formations were discovered on oral examination. These were deep red in colour in both dental arches (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and bled when touched. The orthopantamograph showed an implant in position 15 with no signs of bone resorption or rarefaction of adjacent bone. All other complementary examinations’ findings were normal.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">On hospital admission a computerised tomography (CT) of the face and neck was requested. This revealed subcutaneous cellular tissue inflammation of the upper right dental arch with several necrotic-cystic lesions and swelling of the right apical pleura. Results of analysis showed leucocytosis, increased VSG=172, perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) <3.10 (negative), and perinuclear anti-neutrophil cytoplasmic antibodies (c-ANCA) of 5.10 (mildly positive).</p><p id="par0030" class="elsevierStylePara elsevierViewall">On suspicion of an associated pleural effusion, the study was completed with a CT scan of the thorax, which showed total condensation on the upper right lobe.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Infectious/pulmonary neoplasm processes were ruled out by CT scans of the thorax, abdomen and pelvis, Mantoux, bronchoalveolar lavage (BAL), brochoalveolar aspirate (BAS), and fibrobronoscopy, all of which resulted normal.</p><p id="par0040" class="elsevierStylePara elsevierViewall">On 2 occasions samples were taken of the affected gum. The first showed chronic non-specific inflammation. The second, coinciding with an c-ANCA blood peak above 30<span class="elsevierStyleHsp" style=""></span>pg/ml, showed inflammation, necrosis, granulomas and multinucleated giant cells compatible with WG (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Treatment was initiated with cyclophosphamide and prednisone, which resulted in clinical improvement of the patient after four days. After one week, the granulomatous lesions had almost disappeared from the gum. The patient was periodically monitored by our hospital's rheumatology service.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Although the case we present does not comply with the classical triad relating upper respiratory tract mucous membrane, lower respiratory tract, and kidneys, the gingival affectation described is an alarm signal alerting possible WG.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The discovery of pseudoepitheliomatose hyperplasm from an attached gum biopsy, with multinucleate giant cells and microabscesses confirmed diagnosis of WG.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It has even been described that classical criteria such as vasculitis, granulomas, and necrosis are notably absent in gum biopsies.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Differential diagnosis of this type of gingival alteration should be made with local and well defined systemic entities (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In all previously mentioned cases, the key resides in the anti-neutrophil cytoplasmic antibodies titre (c-ANCA), which is negative in said conditions and positive in WG. However, clinical suspicion together with compatible histopathological study is more sensitive in diagnosis than c-ANCA levels, as they may fluctuate. Drug-induced gingivitis is usually slim and fibrotic, and does not fit the description of this clinical case.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> There is no correlation of c-ANCA values with disease activity.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment with cyclophosphamide and prednisone improved the patient's condition and, as observed, led to the remission of the oral lesions after a few days.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusion</span><p id="par0065" class="elsevierStylePara elsevierViewall">On suspicion of a case of WG, following presentation of non-specific gingivitis erythematous papules, confirmation requires c-ANCA in blood and repeated biopsies.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical Case" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of Interest" ] 5 => array:2 [ "identificador" => "xack75958" "titulo" => "Acknowledgements" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-02-05" "fechaAceptado" => "2012-03-28" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Candau A, Valenzuela B, Dean A, Alamillos FJ. Granulomatosis de Wegener con afectación de la mucosa oral como primera manifestación. Acta Otorrinolaringol Esp. 2014;65:53–55.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 550 "Ancho" => 1000 "Tamanyo" => 114015 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mucosal gingival lesions.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 789 "Ancho" => 1400 "Tamanyo" => 226806 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histological study. Haematoxilin/eosin. Right (4×): histiocytic granuloma with palisade nuceli. Left (10×): necrotising vasculitis.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Local medical condition</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Oral manifestation of HIV</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Tuberculosis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Leishmaniasis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Syphilis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Actinomycosis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Histoplasmosis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Coddidiodomycosis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Blastomycosis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mucormycosis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Aspergillosis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Systemic medical condition</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Crohn's disease</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Wegener's granulomatosis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sarcoidosis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Midline granuloma</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">T/NK lymphomas</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Langerhans cell histiocytosis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Drug-induced gingivitis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Phenytoin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Cyclosporine \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Verapamile \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Nifedipine \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab467695.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara 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"fecha" => "1998" "volumen" => "56" "paginaInicial" => "962" "paginaFinal" => "967" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9710191" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack75958" "titulo" => "Acknowledgements" "texto" => "<p id="par0075" class="elsevierStylePara elsevierViewall">Doctor María Teresa Caro Cuenca, house officer in the Pathological Anatomy service of the Reina Sofía University Hospital.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735735/0000006500000001/v1_201403140154/S2173573514000027/v1_201403140154/en/main.assets" "Apartado" => array:4 [ "identificador" => "5873" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case study" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735735/0000006500000001/v1_201403140154/S2173573514000027/v1_201403140154/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573514000027?idApp=UINPBA00004N" ]
Journal Information
Vol. 65. Issue 1.
Pages 53-55 (January - February 2014)
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Vol. 65. Issue 1.
Pages 53-55 (January - February 2014)
Case Study
Wegener's Granulomatosis With Oral Mucosal Involvement as First Manifestation
Granulomatosis de Wegener con afectación de la mucosa oral como primera manifestación
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Alberto Candau
, Borja Valenzuela, Alicia Dean, Francisco J. Alamillos
Corresponding author
Servicio de Cirugía Oral y Maxilofacial, Hospital Universitario Reina Sofía, Córdoba, Spain
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