Challenges in establishing a definitive diagnosis of the disease underlying a clinical presentation of Desquamative gingivitis

Introduction: Desquamative gingivitis (DG) describes the clinical oral features of several diseases or conditions, including dermatological diseases, endocrine disorders, aging, abnormal response to bacterial plaque, and idiopathic and chronic infections. Clinicians face the challenge of obtaining accurate tissue specimens for laboratory investigations to make a definitive diagnosis. We describe the challenges in establishing a diagnosis of the disease underlying a presentation of DG and discuss the possible causes of inconclusive laboratory findings. Case Report: A 59-year-old woman came to the Oral Medicine Clinic at the Dental Hospital of the Faculty of Dentistry, Universitas Indonesia, complaining of a 3-month history of sore gingiva, which often bled while brushing teeth. She had a history of cavernoma that had been surgically treated. Desquamative and erythematous areas were seen along the buccal/palatal gingiva. Histopathological tissue sample analysis confirmed oral pemphigus vulgaris, but direct immunofluorescence results were negative. Despite this result, a topical corticosteroid was prescribed, and the lesions clinically resolved within 3 months of treatment. The possible causes of inconclusive laboratory findings were explored. Conclusion: The challenges in establishing the diagnosis of the disease underlying the presentation of DG, in this case, included the methods to obtain and handle representative tissue specimens.