REACTION IN ORAL MUCOSA DUE TO INTENSIVE THERAPY POLYPHARMACY: CASE REPORT

Abstract

A 51-year-old white female patient hospitalized in the intensive care unit because of acute ischemic stroke who needed tracheostomy and vasoactive drugs in high dosage evolved with aspiration pneumonia and septic shock. At 30 days of hospitalization, intraoral examination revealed multiple superficial ulcers on the lips, buccal mucosa, tongue, and mouth floor, circumscribed by erythematous halo and covered by pseudomembrane with severe pain symptomatology and evolution of 15 days. Concomitantly, the patient presented bilateral conjunctivitis with erythema in the sclera and periocular region. Several medications were used during hospitalization. Diagnostic hypotheses were erythema multiforme, mucous membrane pemphigoid, and paraneoplastic pemphigus. Incisional biopsy was performed. Histopathologic analysis was suggestive of erythema multiforme. Final diagnosis after clinical correlation was erythema multiforme. Treatment consisted of methylprednisolone and systemic antiviral. After 1 week there was improvement of oral ulcers and conjunctivitis without painful symptoms and transfer to the infirmary. A 51-year-old white female patient hospitalized in the intensive care unit because of acute ischemic stroke who needed tracheostomy and vasoactive drugs in high dosage evolved with aspiration pneumonia and septic shock. At 30 days of hospitalization, intraoral examination revealed multiple superficial ulcers on the lips, buccal mucosa, tongue, and mouth floor, circumscribed by erythematous halo and covered by pseudomembrane with severe pain symptomatology and evolution of 15 days. Concomitantly, the patient presented bilateral conjunctivitis with erythema in the sclera and periocular region. Several medications were used during hospitalization. Diagnostic hypotheses were erythema multiforme, mucous membrane pemphigoid, and paraneoplastic pemphigus. Incisional biopsy was performed. Histopathologic analysis was suggestive of erythema multiforme. Final diagnosis after clinical correlation was erythema multiforme. Treatment consisted of methylprednisolone and systemic antiviral. After 1 week there was improvement of oral ulcers and conjunctivitis without painful symptoms and transfer to the infirmary.