[A 35-year-old man with aggressive periodontitis].

BACKGROUND

Aggressive and necrotic periodontal diseases may occasionally be associated with undiagnosed systemic diseases and immune deficiencies. We present a 35-year-old man with an undiagnosed hypo-gammaglobulinaemia and severe aggressive periodontitis.

MATERIAL AND

METHODS

Gingival biopsies and peripheral blood were collected for immunohistochemical and cell culture studies from the patient with aggressive periodontitis, 3 patients with chronic periodontitis and 3 controls. Mast cells and neutrophils were visualised and counted on histological sections. Freshly isolated monocytes were challenged with lipopolysaccharides and supernatants assayed for interleukin (IL)-1beta, IL-8, IL-10, IL-12 and tumour necrosis factor. Analysis of peripheral blood for any hidden systemic diseases was carried out, including blood cell counts and measurement of immunoglobulin levels in serum.

RESULTS

The patient had depressed levels of immunoglobulin in serum (IgG: 3.2 g/l, IgA: 0.6 g/l and IgM: 0.4 g/l ) and was diagnosed with common variable immunodeficiency. The inflamed gingiva revealed significantly increased numbers of mast cells and neutrophils. Signs of mast cell degranulation were observed in the aggressive periodontitis patient only, and monocytes secreted significantly more IL-1beta, IL-8, IL-12 and tumour necrosis factor, but less IL-10.

INTERPRETATION: Low antibody production concurrent with an obviously increased activity of the innate immune defense with massive release of pro-inflammatory cytokines may partly cause the severe destruction of periodontal tissue as seen in this patient.