Clinical  and Radiographic Findings

The patient presented with severe periodontal disease (Fig 1-3), swollen, red and boggy gingiva, severe calculus, loose teeth, and gingival hemorrhage. The panoramic radiograph showed extensive bone loss and calculus accumulation. She also had extensive cutaneous bruising, especially on the extremities (Fig 4); petechiae; poor and delayed wound healing; lower extremity edema and a non-healing ulcer on the upper arm. She also complained of myalgia and limited range of motion in legs and ankles. The patient also had anemia.

Figure 1.  Patient at presentation demonstrating, swollen, red gingiva and bleeding and ulcerated lips. Figure 2.  Patient at presentation demonstrating severe periodontitis and focal gingival bleeding.

Figure 3. Panoramic view at first presentation demonstrating severe periodontitis and calculus accumulation. Figure 4.  Patient at presentation demonstrating extensive cutaneous bleeding.