Multiple or disseminated pyogenic granulomata? A complex presentation in a 9-yr-old boy.

This report describes the investigation, diagnosis and management of multiple pyogenic granulomata of the maxillary and mandibular gingivae in a nine-year-old boy. The child presented with a history of spontaneous gingival haemorrhage, gastro-intestinal disturbance and a limp involving his left leg. Investigations revealed a neglected child with the unique oral presentation of multiple pyogenic granulomata and syringomyelia involving the spinal chord between the 5 th and 8 th thoracic vertebra, with a consequent motor function deficit that led to the development of a spastic diplegic gate. Joint management with paediatric neurology improved both oral and spinal lesions, but despite arriving at a definitive diagnosis of “disseminated pyogenic granuloma” of the oral cavity, the spinal lesion appeared avascular and was deemed likely to be un-related. The oral lesions were therefore definitively diagnosed and managed as multiple pyogenic granuloma’s rather than disseminated lesions. This report focuses on multiple and disseminated pyogenic granulomata and syringomyelia as medical conditions, their management and the importance of collaborative care pathways between periodontal and neurological physicians in successful management.