Glucocorticoid-Induced Side Effects Cause Oral Lesions in Systemic Lupus Erythematosus: A Case Report.

Abstract

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease with various complications, making its management difficult. Glucocorticoid not only plays an essential role in the pathogenic therapy of SLE but also causes side effects such as oral lesions, especially when administered long-term or at high doses. This case report aims to describe the management of glucocorticoid-induced side effects that cause oral lesions in SLE patient. A 30-year-old woman complained of a sore mouth and mouth-opening difficulty ten days prior. Previously, the patient complained of swelling in the legs and stomach, joint pain, hair loss, and skin redness on exposure to sunlight. Extra-oral examination revealed multiple red-black erosions and crusts on the zygoma region bilaterally over the nasal bridge, well-demarcated with an irregular shape, while the lips bled easily with hemorrhagic crusts that developed into serosanguineous crusts. Intra-oral examination showed scrapable white plaques on the palate, leaving erythematous areas, pain, and ulcers throughout the oral mucosa. The antinuclear antibody (ANA) examination revealed reactive results, positive anti-HSV-1 IgG, and positive hyphal on KOH examination. Based on the examination results, the diagnosis was SLE with herpes virus-associated oral involvement and acute pseudomembranous candidiasis. Comprehensive therapy, including non-pharmacological and pharmacological therapy, was involved. All oral lesions improved within one month. Various oral lesions may appear as manifestations of the disease and side effects of glucocorticoid therapy in SLE patients, thus requiring multidisciplinary monitoring and therapy from various fields.