UNCOMMON AGE, CLASSIC PRESENTATION: PYOGENIC GRANULOMA OF THE GINGIVA IN AN ELDERLY FEMALE
Monisha Sugumaran1, Dr. Bhuvanesh Kuppusami* and Bhagiya Sree
ABSTRACT
Background: Pyogenic granuloma (PG) is a benign, reactive vascular lesion of the oral cavity resulting from chronic irritation, trauma, or hormonal changes. Despite its name, it is neither pyogenic nor a true granuloma. It most commonly affects young adult females, particularly during pregnancy, but can occasionally present in older individuals. Case Presentation: A 64-year-old female presented with a 20-day history of swelling in the right maxillary posterior region. The lesion began as a small swelling and progressively increased in size. The patient had a past medical history of untreated gastric ulcer but no other systemic issues. Intraoral examination revealed a solitary, oval-shaped, soft, and tender swelling measuring 3 × 2 cm in the attached gingiva of teeth 16 and 17. Pus discharge and poor oral hygiene were noted, along with severe calculus and mobility of the involved teeth. A provisional diagnosis of periodontal abscess was made, with peripheral giant cell granuloma as a differential. Excisional biopsy and histopathological analysis revealed stratified squamous epithelium with ulceration, a fibro-purulent membrane, and underlying connective tissue showing capillary proliferation and chronic inflammatory infiltrates—features diagnostic of pyogenic granuloma. Conclusion: This case emphasizes that pyogenic granuloma can occur in elderly patients and may mimic periodontal or other reactive lesions. Thorough clinical evaluation, histopathological confirmation, and complete surgical excision are key for accurate diagnosis and management. The lesion responded well to excision with no recurrence at follow-up, highlighting the effectiveness of early intervention and oral hygiene maintenance.
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