ABSTRACT
We present a rare case of a 34-year-old male with poorly regulated type I diabetes and three-month history of excruciating pain in the right condylar process of the mandible, occurring only during the first bite of each meal. The patient had no history of surgery or trauma in the head and neck region. Clinical and imaging examination revealed no tumor or pathology deriving from the dentures, the temporomandibular joint (TMJ), or the salivary glands. Idiopathic first bite syndrome (FBS) was suspected and treated with pregabalin and glycemic control. This case highlights how a detailed pain history and clinical examination can lead to a rare diagnosis and indicates the potential involvement of diabetic neuropathy in idiopathic FBS, as well as the importance of glycemic regulation in treatment.
ABSTRACT
BACKGROUND: The pathogenesis of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) remains still inconclusive. Recent studies identified an increased expression of BAFF (a B cell-activating factor) and its receptor TACI (Transmembrane Activator and cAML Interactor) in nasal polyp samples, while TNFRSF13B/TACI mutations have been found in patients with benign lymphoproliferative disorders and primary antibody deficiencies. OBJECTIVE: The aim of our study was to evaluate the possible contribution of TNFRSF13B/TACI mutations in CRSwNP pathogenesis. METHODS: Forty-four (44) patients with CRSwNP (male/female: 33/11, mean age: 52.5 years, range: 16-83) were analyzed for TNFRSF13B/TACI mutations by PCR-sequencing. RESULTS: No pathogenic TNFRSF13B/TACI mutations were identified in our cohort study of CRSwNP patients. We detected two common missense mutations (p.P251L and p.V220A), along with other common silent mutations and intronic polymorphisms in an identical prevalence to healthy control population. CONCLUSION: TNFRSF13B/TACI mutations might not play a role in the pathogenesis of CRSwNP.
