# A Presentation of Strawberry Gingivitis as the Initial Presenting Symptom of Recurrence of Granulomatosis With Polyangiitis

## TL;DR

A 48-year-old man with a history of GPA experienced a relapse first shown by strawberry gingivitis, and was successfully treated with a new medication regimen.

## Contribution

This case report highlights strawberry gingivitis as a rare initial sign of GPA recurrence.

## Key findings

- Strawberry gingivitis was the first symptom of GPA relapse in a previously stable patient.
- The patient responded well to a new maintenance therapy including avacopan, azathioprine, and prednisone.
- The patient remained symptom-free after treatment initiation with no signs of relapse.

## Abstract

Granulomatosis with polyangiitis (GPA) is a rare rheumatologic small vessel vasculitis that affects multiple systems, most commonly the sinuses, lungs, and kidneys. In this case report, we detail a case of a 48-year-old male with a past medical history of GPA diagnosed two years ago and no other significant medical history. He presented with isolated gingival edema and discoloration, later identified as strawberry gingivitis, which was the initial presenting symptom of his GPA relapse. The patient's symptoms had been under control since initial induction therapy with IV prednisone, cyclophosphamide, and two doses of rituximab, and he was then continued on a maintenance therapy regimen of azathioprine for two years symptom-free. Upon identification of the patient's relapse, he was treated with a three-week course of oral prednisone to be taken twice daily. His new maintenance therapy regimen included avacopan, azathioprine, and prednisone. Since initiating this therapy, he has remained symptom-free with no new manifestations or signs of relapse.