engleski

Oral cavity erosions – seeking past the obvious

Introduction: Oral ulcers are generally painful lesions that are related to various conditions developing within the oral cavity. Their causes range from minor irritation to malignancies and systemic diseases. Acute oral ulcers can be associated with conditions such as trauma, recurrent aphthous stomatitis, Behçet's disease, bacterial and viral infections, allergies and erythema multiforme. Chronic oral ulcers are associated with conditions such as oral lichen planus, pemphigus vulgaris, mucosal pemphigoid, lupus erythematosus, mycosis and some bacterial and parasitic diseases. The correct diagnosis is essential to establish the appropriate treatment. Case report: A 30-year- old female patient presented with vesicles, bullae and erosions of the oral cavity without skin changes. In the past three years, she had four relapses of equivalent lesions. Pemphigus vulgaris was suspected. Skin biopsy, direct and indirect immunofluorescence were not in line with the diagnosis of autoimmune bullous dermatosis. Autoantibodies against bullous pemphigoid antigens and desmoglein 1 and 3 were all negative. The patient also reported mild skin changes on upper extremities appearing concurrently with third episode of oral changes, in remission during dermatologic examination. Vitamin B deficiency was also considered, but without improvement after vitamin B complex supplementation. She was prescribed with topical treatment for oral mucosa and asked to return when the skin changes reappear. On subsequent examination, she presented with typical target lesions on the dorsal hands and forearms. Severe mucosal involvement was noted with multiple erosions of oral cavity and tongue. Due to typical lesions of the skin, erythema multiforme major was suspected. She reported not previously mentioned recurrent herpes labialis infections preceding lesions in the oral cavity and on the skin. Significant improvement was noted upon treatment with systemic corticosteroids. Oral antiviral drug was recommended as prophylaxis for herpes simplex infection. She remained in remission ever since. Erythema multiforme major is an acute and self- limiting, but potentially recurrent skin eruption characterized by a typical target lesion that also affects mucosa. Herpes simplex virus infection is the most common trigger. Conclusion: Anamnestic information is a key to a diagnosis when clinical presentation is atypical. It is essential to establish a correct diagnosis not only to treat current condition, but also to prevent further relapses, especially when they have such a major impact on the quality of life.

oral ulcer ; oral cavity ; skin biopsy ; erythema multiforme major ; herpes simplex virus

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