Concurrent Mandibular Pyogenic Granuloma and Acute Osteomyelitis Following SARS-CoV-2 Infection: A Case Report
-
Elaheh Ghasemzadeh Hoseini
,
Seyed Mohammad Torabi
,
Hassan Ehteram
,
Bahareh Fattahi
,
Arash Esmaeili
Abstract
This report details a complex oral manifestation of SARS-CoV-2 infection in a 50-year-old female recovering from moderate COVID-19. The patient presented with severe mandibular pain, which upon comprehensive clinical, radiographic, and histopathological evaluation was diagnosed as concurrent advanced pyogenic granuloma and acute osteomyelitis with sequestration in the same jaw quadrant, accompanied by severe bilateral facial paresthesia. The diagnostic process was protracted, with osteomyelitis only confirmed following a subsequent presentation with exposed bone. Management necessitated sequential surgical debridement, targeted antibiotic therapy, and neuropathic pain control with Gabapentin, culminating in eventual resolution. This singular co-occurrence of a reactive vascular lesion and an invasive bony infection suggests a unified pathophysiological model wherein SARS-CoV-2-induced endotheliopathy, cytokine dysregulation, and immune dysfunction collectively establish a permissive local environment for both aberrant angiogenic proliferation and bacterial invasion of bone. The case underscores the imperative for heightened clinical suspicion of complex, co-existing maxillofacial pathologies in post-COVID patients and illuminates the potential therapeutic dilemmas inherent in managing such intertwined inflammatory and infectious sequelae. Keywords: COVID-19; Osteomyelitis; Pyogenic granuloma; Oral manifestations.
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2. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. N Engl J Med. 2020;382(13):1199-207.
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6. Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: a review. J Oral Sci. 2006;48(4):167-75.
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8. Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;12(1):8.
9. Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020;14(2):185-92.
10. Ragab D, Salah Eldin H, Taeimah M, Khattab R, Salem R. The COVID-19 Cytokine Storm; What We Know So Far. Front Immunol. 2020; 11:1446.
11. Teuwen LA, Geldhof V, Pasut A, Carmeliet P. COVID-19: the vasculature unleashed. Nat Rev Immunol. 2020;20(7):389-91.
12. Iba T, Levy JH, Levi M, Connors JM, Thachil J. Coagulopathy of Coronavirus Disease 2019. Crit Care Med. 2020;48(9):1358-64.
13. Bragado R, Bello E, Requena L, Renedo G, Texeiro E, Alvarez MV, et al. Increased expression of vascular endothelial growth factor in pyogenic granulomas. Acta Derm Venereol. 1999;79(6):422-5.
14. Tian Y, Rong L, Nian W, He Y. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther. 2020;51(9):843-51.
15. Hajdamowicz NH, Hull RC, Foster WS, Condliffe AM, Pyle CJ, Allen L, et al. The impact of acute hypoxia on neutrophil degranulation. In: B28. SEPSIS, ARDS, AND MECHANICAL VENTILATION. American Thoracic Society; 2019. p. A4290–A4290.
16. Dym H, Zeidan J. Microbiology of Acute and Chronic Osteomyelitis and Antibiotic Treatment. Dent Clin North Am. 2017;61(2):271-82.
17. Panteli M, Giannoudis PV. Chronic osteomyelitis: what the surgeon needs to know. EFORT Open Rev. 2016;1(5):128-35.
18. Schuknecht B, Valavanis A. Osteomyelitis of the mandible. Neuroimaging Clin N Am. 2003;13(3):605-18.
19. Taboada M, Rodríguez N, Varela PM, Rodríguez MT, Abelleira R, González A, et al. Effect of high versus low dose of dexamethasone on clinical worsening in patients hospitalised with moderate or severe COVID-19 pneumonia: an open-label, randomised clinical trial. Eur Respir J. 2022;60(2):2102518.
2. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. N Engl J Med. 2020;382(13):1199-207.
3. Amorim dos Santos J, Normando AGC, Carvalho da Silva RL, Acevedo AC, De Luca Canto G, Sugaya N, et al. Oral Manifestations in Patients with COVID-19: A Living Systematic Review. J Dent Res. 2021;100(2):141-54.
4. Iranmanesh B, Khalili M, Amiri R, Zartab H, Aflatoonian M. Oral manifestations of COVID-19 disease: A review article. Dermatol Ther. 2021;34(1): e14578.
5. Dos Santos JA, Normando AGC, Carvalho Silva RL, De Paula RM, Cembranel AC, Santos-Silva AR, et al. Oral mucosal lesions in a COVID-19 patient: new signs or secondary manifestations? Int J Infect Dis. 2020; 97:326-8.
6. Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: a review. J Oral Sci. 2006;48(4):167-75.
7. Baltensperger M, Eyrich G. Osteomyelitis of the Jaws. Berlin: Springer; 2009.
8. Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;12(1):8.
9. Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020;14(2):185-92.
10. Ragab D, Salah Eldin H, Taeimah M, Khattab R, Salem R. The COVID-19 Cytokine Storm; What We Know So Far. Front Immunol. 2020; 11:1446.
11. Teuwen LA, Geldhof V, Pasut A, Carmeliet P. COVID-19: the vasculature unleashed. Nat Rev Immunol. 2020;20(7):389-91.
12. Iba T, Levy JH, Levi M, Connors JM, Thachil J. Coagulopathy of Coronavirus Disease 2019. Crit Care Med. 2020;48(9):1358-64.
13. Bragado R, Bello E, Requena L, Renedo G, Texeiro E, Alvarez MV, et al. Increased expression of vascular endothelial growth factor in pyogenic granulomas. Acta Derm Venereol. 1999;79(6):422-5.
14. Tian Y, Rong L, Nian W, He Y. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther. 2020;51(9):843-51.
15. Hajdamowicz NH, Hull RC, Foster WS, Condliffe AM, Pyle CJ, Allen L, et al. The impact of acute hypoxia on neutrophil degranulation. In: B28. SEPSIS, ARDS, AND MECHANICAL VENTILATION. American Thoracic Society; 2019. p. A4290–A4290.
16. Dym H, Zeidan J. Microbiology of Acute and Chronic Osteomyelitis and Antibiotic Treatment. Dent Clin North Am. 2017;61(2):271-82.
17. Panteli M, Giannoudis PV. Chronic osteomyelitis: what the surgeon needs to know. EFORT Open Rev. 2016;1(5):128-35.
18. Schuknecht B, Valavanis A. Osteomyelitis of the mandible. Neuroimaging Clin N Am. 2003;13(3):605-18.
19. Taboada M, Rodríguez N, Varela PM, Rodríguez MT, Abelleira R, González A, et al. Effect of high versus low dose of dexamethasone on clinical worsening in patients hospitalised with moderate or severe COVID-19 pneumonia: an open-label, randomised clinical trial. Eur Respir J. 2022;60(2):2102518.
| Files | ||
| Issue | Vol 13, No 1 (Winter 2026) | |
| Section | Case Report(s) | |
| Keywords | ||
| COVID-19; Osteomyelitis; Pyogenic granuloma; Oral manifestations. | ||
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|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Hoseini E, Torabi SM, Ehteram H, Fattahi B, Esmaeili A. Concurrent Mandibular Pyogenic Granuloma and Acute Osteomyelitis Following SARS-CoV-2 Infection: A Case Report. J Craniomaxillofac Res. 2026;13(1):129-133.
