Case history and examination
A 14-year-old male patient first presented to the clinic on Oct 12th, 2021, with gingival hemorrhage and full-maxillary tooth movement, leading to feeding difficulties. His family history and medical history were unremarkable. Earlier in late September 2021, he had noticed bilateral mandibular molar tooth movement and gingival swelling around the molars. Despite occlusal adjustment by a local dentist, the symptoms did not improve, the gingival swelling spread to the entire jaw, and he began to bleed easily. Later, due to tooth movement and worsening gingival bleeding, he had difficulty with oral intake and presented to our department for examination and treatment in late October.
Upon clinical examination, the patient had a body temperature of 37.4°C, signs of fatigue, and a relatively lean body condition (height, 162 cm; weight, 38.5 kg; body mass index, 14.7 kg/m2). He reported that he could only take soft food orally.
He had pain in both knees, elbows, and shoulder joints. Scattered petechial hemorrhagic patches were observed on the dorsal surfaces of his feet and abdomen (Fig 1), and his liver and spleen were enlarged on palpation.
His face was symmetrical. His maxillary and mandibular gingiva were bleeding, erythematous, and swollen (Fig 2A), with significant tooth movement observed in all jaws (Table 1A) and uneven occlusion of the bilateral molars.