Oral lesions indicative of plasminogen deficiency (hypoplasminogenemia)

Background. Gingival overgrowth with ulceration has recently been recorded in 4 reports: (1) our report of a British patient with ligneous conjunctivi tis in whom the gingival lesions appeared to be related to tranexamic acid- an antifibrinolytic agent; (2) a report of 2 Turkish patients and an Italia n patient with mainly gingival lesions; (3) our report of 5 Turkish patient s with mainly gingival lesions; and (4) a report of 3 new Turkish cases, wh ich also were associated with gingival lesions and alveolar bone loss. Thes e patients all had gingival swellings, and a minority had conjunctival invo lvement similar to ligneous conjunctivitis, although the etiology was uncle ar in all. Nevertheless, fibrin exudation was fundamental because the hyali ne or amyloidaceous material seen on the gingival biopsy stained for fibrin but failed to stain for amyloid. Methods. We have examined 6 more patients who exhibited gingival swelling c aused by amyloidaceous deposits that stained only for fibrin, and we assaye d their plasminogen levels. Results. The plasminogen functional activity assayed in these 6 additional patients, and in 2 of the 5 patients previously reported by us, was signifi cantly reduced. Conclusions. Gingival overgrowth with ulceration appears to be a new compli cation caused by plasminogen deficiency; it also appears to be related to l igneous conjunctivitis in some cases.