Oral manifestation of Crohn's disease without concomitant gastrointestinal involvement.

Crohn's disease (CD) is a chronic relapsing inflammatory disorder of unknown etiology and uncertain pathogenesis with no known cure. CD can involve any segment of the gastrointestinal tract, and oral lesions consistent with granulomatous ulcers are considered an important extra-intestinal manifestation. Oral lesions in the absence of gastrointestinal involvement are rarely reported. We report a case of a 64-year-old man with a history of CD that was in remission for three decades, presenting with painful cobblestone-like ulcerations of the oral mucosa, but without gastrointestinal signs or symptoms. Surgical biopsy of the oral lesions revealed non-necrotizing chronic granulomatous ulcers on histopathologic examination, similar to results from a biopsy of his small intestine three decades previously which established his diagnosis of CD. The patient was successfully treated with potent topical corticosteroids which resulted in resolution of the oral lesions and associated symptoms.

Metagenomic investigation of microbes and viruses in patients with jaw osteonecrosis associated with bisphosphonate therapy.

OBJECTIVE: The goal of this preliminary study was to use metagenomic approaches to investigate the taxonomic diversity of microorganisms in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). STUDY DESIGN: Samples of saliva for planktonic microbial analysis and biofilm cultivation were collected from 10 patients (5 with BRONJ and 5 non-BRONJ control subjects) who met all ascertainment criteria. Prophage induction experiments-16S rRNA polymerase chain reaction and 454 pyrosequencing-and epifluorescent microscopy were performed for characterization and enumeration of microbes and viruses. RESULTS: Three phyla of microbes-Proteobacteria (70%), Firmicutes (26.9%), and Actinobacteria (1.95%)-dominated all BRONJ samples and accounted for almost 99% of the total data. Viral abundance was ∼1 order of magnitude greater than microbial cell abundance and comprised mainly phage viruses. CONCLUSIONS: Individuals with jaw osteonecrosis harbored different microbial assemblages than nonaffected patients, and in general viral abundance and prophage induction increased with biofilm formation, suggesting that biofilm formation encouraged lysogenic interactions between viruses and microbial hosts and may contribute to pathogenicity.