Liver and kidney foreign bodies granulomatosis in a patient with malocclusion, bruxism, and worn dental prostheses

Granulomatous reactions caused by foreign bodies have been described in dru g abusers, in subjects exposed to occupational pollutants, and more rarely, in association with the use of prosthetic devices. We describe a 62-year-o ld patient with multiorgan parenchymal granulomatosis caused by inorganic d ebris of unknown origin. The patient presented with fever, hepatosplenomega ly, progressive cholestasis, and acute renal failure. Liver and kidney biop sies showed the presence of noncaseating epithelioid giant-cell granulomas- containing scattered polarizable particles. Similar particles were also pre sent in stools. Studies by innovative scanning electron microscopy and ener gy-dispersive microanalytical techniques showed that the particles isolated in liver, kidney, and stools were made by feldspars, the main, component o f porcelain. No occupational or environmental exposure to these materials c ould be identified in this patient and the only reliable source of the porc elain debris turned out to be constituted by 2 dental bridges evidently wor n because of a possible inappropriate construction, malocclusion, and bruxi sm. The porcelain of the dental prostheses had the same elemental spectrum of the particles isolated from stool specimens and liver-kidney granuloma. After identification of the dental. prostheses as the most likely source of ceramic debris, and after their removal, the particles from stool specimen s disappeared. The patient was then treated with steroids leading to a remi ssion of the clinical symptoms and a decrease in granulomatous inflammatory reaction. in both liver and kidney. This is the first report suggesting th at a foreign body systemic granulomatosis can be associated with worn denta l prostheses.