Plasma cell mucositis in a lung transplant patient

Abstract

Bhattacharyya and associates recently reported prominent “cobblestone” papillomatosis involving the entire lower lip vermilion border occurring in a boy on immunosuppressive therapy (including cyclosporin) to prevent rejection of transplanted lungs.1Bhattacharyya I. Islam M.N. Yoon T.Y.H. Green J.G. Ohja J. Liu J.J. et al.Lip hypertrophy secondary to cyclosporine treatment: a rare adverse effect and treatment considerations.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102: 469-474Google Scholar Excised lip tissue demonstrated papillary fibroepithelial hyperplasia with irregular acanthosis, suprapapillary epithelial atrophy, and a dense infiltrate of plasma cells in the superficial connective tissue. These clinical and histologic features evoke consideration of plasma cell orificial mucositis (also termed mucous membrane plasmacytosis or oral papillary plasmacytosis).2Smith M.E. Crighton A.J. Chisholm D.M. Mountain R.E. Plasma cell mucositis: a review and case report.J Oral Pathol Med. 1999; 28: 183-186Google Scholar, 3White Jr, J.W. Olsen K.D. Banks P.M. Plasma cell orificial mucositis.Arch Dermatol. 1986; 122: 1321-1324Google Scholar, 4Ferreiro J.A. Egorshin E.V. Olsen K.D. Banks P.M. Weiland L.H. Mucous membrane plasmacytosis of the upper aerodigestive tract.Am J Surg Pathol. 1994; 18: 1048-1053Google Scholar, 5Khan N.A. McKerrow W.S. Palmer T.J. Mucous membrane plasmacytosis of the upper aerodigestive tract A case report with effective treatment.J Laryngol Otol. 1997; 111: 293-295Google Scholar, 6Grattan C.E.H. Gentle T.A. Basu M.K. Oral papillary plasmacytosis resembling candidosis without demonstrable fungus in lesional tissue.Clin Exp Dermatol. 1992; 17: 112-116Google Scholar, 7Noorily A.D. Plasma cell orificial mucositis.Otolaryngol Head Neck Surg. 1997; 116: 416-417Google Scholar This condition tends to affect mucosa of the supraglottic larynx, lips, palate, and gingiva.2Smith M.E. Crighton A.J. Chisholm D.M. Mountain R.E. Plasma cell mucositis: a review and case report.J Oral Pathol Med. 1999; 28: 183-186Google Scholar Plasma cell mucositis typically shows mucosal erythema in addition to the characteristic cobblestone surface. Although the Bhattacharyya case exhibited little evidence of such erythema, case 2 of the Cansick and Hulton8Cansick J.C. Hulton S.-A. Lip hypertrophy secondary to cyclosporin treatment.Pediatr Nephrol. 2003; 18: 710-711Google Scholar report showed obvious erythema and surface papillomatosis consistent with plasma cell mucositis. Unfortunately, the lip lesions were not biopsied in the 2 Cansick and Hulton cases, so the nature of the histologic alteration is uncertain. However, fibrous hyperplasia associated with little inflammation, as occurs in cyclosporin-induced gingival enlargement, would be expected to present as pink firm tissue, not red tissue. Therefore, one could hypothesize that case 2 of the Cansick and Hulton report displayed inflammation; although speculative, this inflammation could potentially have been similar to that seen in the Bhattacharyya case. The cause of plasma cell mucositis is unclear, but it could represent a hypersensitivity reaction to a microbial or chemical antigen. In short, plasma cell mucositis should be included in the differential diagnosis of the unusual condition reported by Bhattacharyya and colleagues. In replyOral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and EndodonticsVol. 103Issue 6PreviewWe thank Dr. Slater for his comments. Mucous membrane plasmacytosis could certainly be included in the differential diagnosis for the lip hypertrophy secondary to chronic cyclosporine use. However, the lack of erythema in the hyperplastic lip and gingival tissues would be more characteristic of classical cyclosporine-induced hyperplasia. The presence of the patchy dense plasmacytic/lymphocytic inflammatory infiltrate could well be explained by the tremendous overgrowth of the lip tissue with resultant mouth breathing and trauma. Full-Text PDF