Buccal Ulcer Research Articles

咽頭癌を疑われたパラコクシジオイデスの１例

Paracoccidioidomycosis is a fungal infection endemic to South American countries that affects the lungs, skin, and mucosae. Reports from Japan are limited by a long-term resident in South America. Some cases are incorrectly diagnosed because of a refractory buccal ulcer that resembles a malignant tumor. This is a disease that may not be correctly examined if we cannot suspect by a case history. We report the case of a Brazilian man who had a buccal ulcer with lung involvement, which mimicked pharyngeal cancer.

Tongue angioedema in vivo: Antagonist response of anti-inflammatory drugs

Introduction. The toxicity of Dieffenbachia picta, an ornamental plant, arises from its ability to cause painful edema of oral mucous membranes, buccal ulcerations, and tongue hypertrophy after chewing on the stem or contact with the sap. Objectives. We compared the anti-inflammatory effect of eugenol (2-methoxy-4-(2-propenyl)phenol) to different drugs, and investigated the role of oxalate crystals in the development of the inflammation reaction. Methods. Tongue edema in live mice were measured with a digital tachymeter, 2 h after topical application (0.1 mL) or tissue injection (0.05 mL) of D. picta sap. The mice were treated by intraperitoneal or topical application of drugs, 15 min after edema induction. Vascular permeability was quantified based on abdominal skin plasma extravasation of Evans blue dye in response to intradermal administration of D. picta sap. The proteolytic assay was carried out as previously described (Kunitz M. Crystalline soybean trypsin inhibitor. General properties. J Gen Physiol 1947; 30:291–310.). Results. Arachidonate cascade antagonists and eugenol showed anti-edematogenic effects. High doses of eugenol (50 μg/kg) and sodium cromoglycate (100 mg/kg), but not a combination of the two, inhibited plasma extravasations. The sap without crystals, its methanol extract, or the ethanol-washed crystals in saline-reconstituted solution did not reproduce the tongue edema seen with the original sap. Topical application of 10% sodium bicarbonate completely abolished the tongue edema. Conclusions. The inflammatory response induced by D. picta may be due to mechanical tissue damage resulting from the physical presence of calcium oxalate crystals. We were, however, unable to exclude the possibility of an insoluble toxicity present within the sap as an etiological agent. We realized that emergency treatment should also aim to inhibit antidromic vasodilation and axon reflex flare, reducing mastocyte degranulation and release of tachykinins from nerve endings. We speculate that eugenol showed better antiedematogenic results because it seems to function not only as a classic non-steroidal anti-inflammatory drug, but also as a local anesthetic, blocking neurotransmission in the damaged tissue.

Nodular secondary syphilis

Auteur(s) : Aristoteles ROSMANINHO arisrosmaninho@gmail.com, Madalena SANCHES, Ines LOBO, Rosario ALVES, Manuela SELORES Department of Dermatology, Centro hospitalar do Porto-HSA, Rua D. Manuel II s/n°, 4099-001 Porto, Portugal A 64-year-old man presented with an eighteen-day history of a non-pruritic eythematous eruption localized to his upper limbs, neck and back. He denied recent genital or buccal ulceration or heterosexual extramarital sexual intercourse as well as systemic complaints. His [...]

Reply: Coin-shaped epithelial lesions following an acute attack of erythema multiforme minor with confocal microscopy findings

Dear Editor, We thank Jain et al.[1] for their interest in our article.[2] We do agree that these lesions do improve with topical steroids. What is important here is the presence of additional systemic features like skin eruptions or involvement of a mucosa. In our patient, there were skin eruptions and painful buccal mucosal ulcers following a viral illness. Herpes simplex virus-induced erythema multiforme (EM) minor constitutes 15-60% of EM minor. The treatment is a combination of acyclovir and oral steroids.[3] Treatment with oral steroids along with oral acyclovir is definitely justified in our case. In contrast, we do see cases of EM minor with only ocular involvement in the form of coin-shaped lesions which will definitely improve only with topical steroids just like the case described by Jain et al.[1] As we have described the confocal microscopy findings speculating an immunological mechanism in the development of these coin-shaped lesions on the cornea, these lesions will definitely respond to topical steroids.

Index of Suspicion * Case 1: Recurrent Oral Ulcers in an Adolescent * Case 2: Visual Impairment in an Autistic Child * Case 3: Fever and Hepatosplenomegaly in an Infant

A 16-year-old African American girl presents with extremely painful recurrent oral ulcers over the past 2 months. She reports similar painful ulcers of the genital area that have whitish discharge and intermittent low-grade fevers. A recent complaint of blurry vision prompted a visit to an ophthalmologist, who prescribed eye drops for “inflammation.” She denies sexual activity, drug use, nausea, vomiting, diarrhea, headaches, rash, joint pains, cough, or frequent infections. Her past medical history is unremarkable, but an older brother has human immunodeficiency virus (HIV) infection. Physical examination reveals a well-developed adolescent girl in no acute distress. Her vital signs are within age-appropriate limits. She has several well-demarcated aphthous ulcers in her buccal mucosa and oval ulcers with whitish discharge over her labia majora. The remainder of the physical examination yields no findings of note. Laboratory testing reveals normal findings on a complete metabolic panel, urinalysis, and serum immunoglobulin and complement assessment. Her Hgb is 11.5 g/dL (115 g/L) and her ESR is elevated at 55 mm/hr. Serologic testing reveals negative titers for herpes simplex virus (HSV) types 1 and 2; HIV; cytomegalovirus; Toxoplasma ; and hepatitis A, B, and C. HSV cultures from ulcers as well as gonococcus and Chlamydia DNA and rapid plasma reagin tests are negative. Antinuclear and antidouble-stranded DNA antibodies are negative. However, a test for antiphospholipid antibodies is mildly positive to B2 glycoprotein. Biopsy results are consistent with vulvitis. A discussion with the patient's ophthalmologist confirms the clinical diagnosis and well-known complication. A 15-year-old Hispanic boy who has a previous diagnosis of autism presents to the ophthalmology clinic with a 2-month history of vision problems. His parents report that he does not walk around freely because he cannot see, he holds on to walls, and he runs into the furniture. He is no longer able to …

Jugular Thrombophlebitis Developed from Buccal Ulcer in a Thoroughbred Horse

A 22-year-old Thoroughbred stallion had severe left jugular thrombophlebitis. Macroscopic and microscopic examinations revealed extension of the lesions from a penetrating ulcer on the left buccal mucosa to the underlying muscle and local vein, and sequentially to the left jugular vein. This was a rare case of equine jugular thrombophlebitis caused by direct extension of infection from a traumatic oral lesion.

A Biodegradable Esophageal Stent in the Treatment of a Corrosive Esophageal Stenosis in a Child

A Biodegradable Esophageal Stent in the Treatment of a Corrosive Esophageal Stenosis in a Child

The prevalence of oral ulceration in Swedish horses when ridden with bit and bridle and when unridden

Oral soft tissue ulcers are common disorders of horses, but it is unclear if their prevalence is increased by riding horses with a bit and bridle. Oral examinations were performed on 113 horses and ponies, all which had received routine dental floating, that were divided into four groups depending on when they had last been ridden with a bit and bridle. The subjects comprised: group 1, a randomly selected population of ridden horses; group 2, a group of horses examined after being rested at pasture for 5 weeks; group 3, the previous group following 7 weeks of riding with a bit and bridle, and group 4, brood mares that had not been ridden for at least 11 months. Lip and intraoral soft tissue lesions were recorded at seven pre-determined locations, with lesions classified as large or small; acute or chronic. The examinations showed that horses that were currently being ridden with a bit and bridle had a significantly higher prevalence of large and acute buccal ulcers opposite the maxillary Triadan 06 teeth and of the commissures of the lips, as compared to horses that were not being currently ridden. It was concluded that using a bit and bridle can cause oral ulceration even in horses that have regular prophylactic dental floating. It is suggested that riding tack should be individually fitted for each horse and also that prophylactic dental treatments should be individually adapted for each horse.

Clinical dental findings in 203 working donkeys in Mexico

Clinical dental examinations of 203 unsedated working donkeys in tropical and temperate climatic areas in Mexico revealed a high prevalence (62%) of dental disease with sharp enamel points present in 98% of the animals. More significant dental disorders (diastemata, 4%; overgrown teeth, 18%; worn teeth, 16%; missing teeth, 0.5%; displaced teeth, 1.5%; fractured teeth, 2%) with welfare implications that required immediate treatment were also present in 18% of donkeys. The high prevalence of buccal ulcers (14.3%) and calluses (13.3%) present in this population was believed to be due to the high prevalence of sharp enamel points in conjunction with the use of tight nose bands and head collars. Dental disease was significantly associated with age groups, but not with body condition score or to the climatic area where the donkeys lived. As part of more general examinations, 81% of donkeys that had faecal egg counts performed, had parasite burdens which mainly showed a moderate level of infection. This study concluded that dental disease is a welfare concern in working donkeys in Mexico.

A 6-Year-Old Child with Fever of Unknown Origin, Anemia, and Abdominal Pain

The patient is a previously healthy 6-year-old Caucasian girl with a 1-month history of fever, anemia, diminished appetite, and a 3-pound weight loss. She had received courses of trimethaprim-sulfamethoxazole and amoxicillin for suspected sinusitis and lower urinary tract infections. Despite this treatment, fever up to 104°F persisted, occurring primarily in the evenings. Although there were no identifiable preceding human sick contacts, her dog had died from canine parvovirus infection 1 month before the onset of her symptoms. The patient presented as a pale child in the 50th and 75th percentiles for weight and height, respectively. She was normotensive, with a hyperdynamic tachycardia during febrile periods. Her physical examination was notable for mild nail clubbing, along with mild, diffuse abdominal tenderness with no palpable mass or hepatosplenomegaly. Her stools were positive for occult blood before she received any aspirin or nonsteroidal anti-inflammatory drug therapy. The ophthalmologic examination was normal. Laboratory findings indicated profound systemic inflammation, anemia, elevated D-dimers, sterile pyuria, and twice the normal levels of transaminases (Table I; available at www.jpeds.com). The initial peripheral blood examination revealed a normochromic, normocytic anemia with reticulocytopenia, moderate neutrophilia, atypical lymphocytes, occasional Dohle bodies without significant toxicity, and Rouleaux formation suggestive of an inflammatory process. Evaluation of a bone marrow specimen revealed hypocellularity (60%), with the erythroid series shifted to the left with many pronormoblasts, some of them giant, suggesting early recovery from marrow suppression. In addition, large normoblasts exhibited intranuclear inclusions suggestive of a viral process. Serum antinuclear antibody and antineutrophil cytoplasmic antibody tests were negative. Cultures of the patient’s blood, urine, and stool were negative. Blood polymerase chain reaction (PCR) studies for adenovirus and enterovirus, in addition to serologies to Epstein-Barr virus, toxoplasma, cytomegalovirus, parvovirus B19, bartonella, leptospirosis, and Coxiella burnetii, failed to identify an infectious etiology for this prolonged illness. Because of the patient’s anemia, reticulocytopenia, and parvovirus exposure, parvovirus remained an etiologic consideration. Initially, the patient received aspirin and 2 doses of intravenous immune globulin for presumed atypical Kawasaki disease, but a later echocardiogram was normal. After this treatment, her fever resolved for 36 hours, but then returned. Two months into the patient’s illness, her anemia worsened, necessitating multiple packed red blood cell transfusions. She also began experiencing daily intermittent headaches coinciding with worsening periumbilical abdominal pain, a painful buccal ulceration, and pelvic and low back pain. Her fevers became more hectic, with nighttime diaphoresis but without rigor. Nonsteroidal medication was discontinued because of her increasing abdominal pain, nausea, and vomiting (with an episode of coffee-ground emesis). Her urinalysis demonstrated microscopic hematuria.

Non-healing anal ulcers associated with nicorandil

Nicorandil-associated anal ulceration was initially described in 2002. Since then a number of reports from different centres have described series of patients who developed atypical anal ulcers while taking the drug. Ulceration is not confined to the anal area: buccal, small bowel and peristomal ulceration have also been described.6-8 There is often a considerable delay in associating these ulcers with the drug. A large proportion of these patients will be under the care of nurses involved in wound care; the aim of this article is to bring nicorandil-associated ulceration to the attention of these wound-care practitioners.

P0250* SAFETY AND EFFICACY OF SIROLIMUS IN CHILDREN FOLLOWING CHRONIC REJECTION AND/OR NEPHROTOXICITY POST INTESTINAL TRANSPLANT (ITX) AND LIVER TRANSPLANTATION (LTX).

Introduction: Chronic rejection after transplantation and drug induced nephrotoxicity continue to be major clinical problems. Sirolimus is a potent immunosuppressant acting on the mTOR receptor with no adverse effects on renal function. AIM To evaluate the safety and efficacy of Sirolimus in intestinal transplantation (ITx) and liver (LTx) transplant recipients in children. Methods: Retrospective review from Jan ’01 to Dec ’02. 14 children (9M): renal toxicity (n=5);recurrent rejection/acute steroid resistant rejection after ITx and/or LTx (n=9) were included. Results: Median age at transplant (Tx): 34 months. Median time post Tx at starting Sirolimus: 41.8 months. Sirolimus treatment followed up for 100–500 days. Patients receiving Sirolimus due to nephrotoxicity showed an improvement in cGFR from 52 to 73 ml/ml/1.73m2. Liver function tests improved in those with recurrent rejection and small bowel allograft function. Table 1 summarises data on efficacy and safety of Sirolimus. Adverse events: Infection: pneumonia (7 episodes), adenovirus (1), Influenza (1), EBV viraemia (4) and staphylococcus (2). Two children developed mucosal lesions, buccal mucosal ulcer (1) and candidial oesophageal lesions (1). 3 patients developed high triglycerides not requiring treatment. 5 children experienced transient thrombocytopaenia. Sirolimus temporarily withheld for EBV viraemia (1) and discontinued(1)for protracted neutropenia. Two patients with intestinal graft died after 8m and 15m exposure to Sirolimus (bowel perforation and fungal endocardititis).Table 1Conclusion: Sirolimus as a concomitant immunosuppressant is effective in acute steroid resistant and chronic rejection for ITx/LTx recipients. We recommend caution in the long term use of Sirolimus in ITx recipients

Ability of eugenol to reduce tongue edema induced by Dieffenbachia picta Schott in mice

Dieffenbachia picta Schott (Araceae), known in Brazil as ‘comigo-ninguém-pode’ is an ornamental plant with toxic properties. Its juice, when chewed, causes a painful edema of the oral mucous membranes, buccal ulcerations and tongue hypertrophy. This acute inflammation sometimes becomes severe enough to produce glottis obstruction, respiratory compromise and death. Eugenol (4-alil-2-metoxiphenol), the essential oil extracted from Caryophyllus aromaticus (Myrtaceae) is widely used in odontology. In this study, our objective was to standardize, in mice, a measurable methodology for the tongue edema induced by the topical application of the D. picta stem juice; evaluate the effects of eugenol in this model and compare the results with emergency treatment used in hospitals. Our results show that in spite of a small increase in edema a few minutes after administration, emergency treatment reduced by 70% the overall edema. When compared with the combination of the above drugs, eugenol, even at the smallest dose of 5 μg/kg, regardless of the chosen administration route, or the moment the treatment began, presents better results in the reduction and inhibition of the tongue edema induced by the D. picta juice.

A Prospective Study of Cutaneous Adverse Events Induced by Low-Dose Alpha-Interferon Treatment for Malignant Melanoma

Introduction: α-Interferon is associated with numerous cutaneous side effects, but the accurate incidence of these complications is not clearly known. Objectives: A prospective study was designed to evaluate the incidence and clinical pattern of cutaneous side effects in a cohort of patients receiving adjuvant therapy with low-dose interferon for malignant melanoma. Material and Methods: A cohort of 33 patients with stage IIA and IIB melanoma treated with low-dose α-interferon (3 MIU 3 times a week for 18 months) were prospectively enrolled in a single-center study. The patients responded to a questionnaire on their medical history and were systematically examined for any cutaneous lesions before treatment and every 3 months afterwards. Results: 29/33 patients (87%) experienced 1 or more cutaneous side effects. The most frequent was hair loss and occurred in 16 cases (48.4%). Hair discoloration was noted in 6 cases (18%). Eczematous reactions at injection sites or at remote sites were observed in 13 patients (39%). Pruritus occurred in 10 cases (30%). Xerostomia, Raynaud’s phenomenon or livedo reticularis were observed in 10 patients, associated with an increase in circulating autoantibody titer in 2 cases. Some rare side effects were observed: urticaria (1 case) or angioedema (1 case), worsening of preexisting seborrheic dermatitis (3 cases), herpetic recurrence (2 cases), pityriasis versicolor (1 case), worsening of recurrent buccal aphthous ulcer (1 case) and vitiligo (1 case). Conclusion: Cutaneous adverse events during adjuvant immunotherapy of melanoma with low-dose α-interferon seem to be frequent but do not result in treatment discontinuation. A good awareness of these side effects may be useful for a more accurate survey and clinical management of patients receiving this treatment.

Non-specific elevation of antistreptolysin antibody (ASO) in the absence of streptococcal pharyngitis

Rationale Elevated antistreptolysin antibody (ASO) has been found in five patients without history, physical findings, rapid antigen tests or cultures suggestive of streptococcal pharyngitis. Methods Histories and data are reviewed. Results 1. JK, 10 year old male, presented with urticaria, lymphadenopathy and oral ulcers following treatment with amoxycillin and clarithromycin. Past history included recent Stevens-Johnson syndrome. Laboratory tests: elevated antinuclear antibodies (1:320), elevated erythrocyte sedimentation rate, neutropenia and massive elevation of ASO at 2,638 (0-200 IU/ml). Diagnosed with drug induced lupus. 2. JA, 56 year old, with hyper-IgM syndrome and bronchiectasis, treated with intravenous immunoglobulin (IVIG), presented with leukocytoclastic angiitis. Laboratory tests: positive antineutrophil cytoplasmic antibodies (ANCA) and suppressed complement. Two months after discontinuation of IVIG ASO was 91 U/dL (0-85) but eventually normalized. Reintroduction of IVIG was tolerated without elevation of ANCA or ASO. 3. KB, 19 year old female, referred for recurrent sinusitis, lymphadenopathy, buccal ulcers and recent mononucleosis, had elevated antinuclear antibodies and suppressed complement. ASO has been borderline (84 U/dL) and mildly elevated (96 U/dL, reference: 0-85). Diagnosed with Sjoegren syndrome. 4. TS, 35 year old, presented with chronic urticaria for 6 years, started shortly after his diagnosis with Guillain-Barre syndrome. Chronic inflammatory demyelinating polyneuropathy is possible. ASO titers vary from 71 to 95 U/dL (reference 0-85). 5. DM, 7 year old, presented with angioedema-urticaria, due to penicillin allergy. ASO titer was 242 U/dL (reference 0-200). Conclusions Elevated ASO titers occur without streptococcal pharyngitis. Polyclonal activation of B-cells due to autoimmunity, drug allergy or viral infections, is a likely mechanism.

Buccal mucosal ulcer healing effect of rhEGF/Eudispert hv hydrogel.

We have studied the effect of rhEGF on the buccal mucosal ulcer healing. rhEGF was rapidly degraded upon incubation with the hamster buccal mucosal homogenates; The degradation of rhEGF was significantly inhibited by sodium lauryl sulfate (SLS). Eudispert hv hydrogel and Polycarbophil 974P hydrogel were prepared for rhEGF delivery and their mucoadhesiveness was measured by the Instron method. The mucoadhesive force of Eudispert hv was significantly greater than that of Polycarbophil 974P. Moreover, rhEGF in Eudispert hv hydrogel remained stable for about 2 months. To evaluate the ulcer healing effect of rhEGF, the buccal mucosal ulcer was induced in golden hamsters using acetic acid. At 24 h after administration of rhEGF/Eudispert hv hydrogel, the ulcerous area was decreased compared with rhEGF solution and, as a result, the curative ratio was 36.8 +/- 5.68%. By the addition of SLS (0.5%) to Eudispert hv hydrogel, the curative ratio increased 1.5 times. The mechanism of the action was probably due to a combination of protection of the drug against proteases present in mucosa and prolongation of the release of rhEGF from the formulation at the site of action.

Miliaire cérébrale pseudonéoplasique révélatrice d’une histoplasmose disséminée à Histoplasma capsulatum :difficultés diagnostiques, échec thérapeutique

Introduction. – Infection with Histoplasma capsulatum (Hc) is a rare importing disease in metropolitan France, the most often minor but sometimes letal in its spread form. Exegesis. – A 58 years old French man, HIV seronegative, was admitted for an alteration of its general condition, disorder and buccal ulcerations. He had a prostate cancer history and came back in France after 17 years in Central Africa. The imaging showed numerous cerebral nodes, a bilateral adrenal tumor, and pulmonary calcifications. Histoplasmosis diagnosis has been done after neurosurgical cerebral biopsy wich displayed characteristic Hc. The sick man died 4 months later with multivisceral failures, in spite of amphotericine B treatment followed by oral then intraveinous itraconazole. Conclusion. – Even in an old tropical residence, ones can be able to conjure up a deep exotic fungal infection, and most specifically Hc histoplasmosis, in front of meaningful multivisceral lesions. Disseminated histoplasmosis (HD) with neurological location is misleading, mimicking tuberculosis or cancer. In order to obtain formal mycological evidence, ones have to make adapted biopsies. Antifungal agents must take into account medicinal interaction. Therefore, prognosis is bad, according to inoculum, immunodeficiency, age of disease and diagnosis delay.

Therapeutic effect of rebamipide in a modified acetic acid-induced buccal mucosal ulcer model

Previous studies have suggested that rebamipide, a gastroprotective drug, might be effective for the treatment of aphthous oral ulcers in Behcet's disease patients. The aim of this study was to confirm the effect of rebamipide on experimentally induced stomatitis in a rat acetic acidinduced oral ulcer model. Buccal mucosal lesions were induced by local injection of 50 μl of 99.7% acetic acid into the buccal mucosa, which produced a single large ulcer in each of the treated rats. The ulcer remained up to 14 days. Repeated dose of rebamipide (3-100 mg/kg) dose-dependently decreased the ulcer area. Histopathologically, increased fibrosis and regenerated epithelium were observed in the rebamipide-treated group. In contrast, indomethacin, a cyclooxygenase inhibitor, impaired the healing of ulcers. We have successfully established an improved method for the administration of acetic acid to induce oral ulcers, and rebamipide accelerated the ulcer healing.

Telomerase activity detected in oral lichen planus by RNA in situ hybridisation: not a marker for malignant transformation

Background: Oral lichen planus (OLP) is a chronic inflammatory condition. Clinically, it is characterised by the presence of a white lace-like lesion on the buccal mucosa, tongue, and gingivae, with...

Nonsteroidal anti-inflammatory drug ingestion interferes with cessation of apoptotic events during oral mucosal ulcer healing

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is a leading cause of gastrointestinal injury, but little is know about the effect of these agents on the integrity of soft oral tissue. We investigated the rate of buccal mucosal ulcer healing and the apoptotic processes in rats subjected to intragastric administration of NSAIDs. Groups of rats with acetic acid-induced buccal mucosal ulcers were administered orally twice daily for up to 10 days with indomethacin (5 mg/kg), or aspirin (20 mg/kg), or the vehicle, and their mucosal tissue was used for macroscopic assessment of ulcer healing rate and biochemical measurements. While in the control group the ulcer healed by the tenth day, the animals subjected to indomethacin showed only a 57.2% reduction in the ulcer area and a 54.8% reduction was attained in the presence of aspirin. The healing was reflected in a decrease in apoptosis and a decline in buccal mucosal expression of tumor necrosis factor-α (TNF-α) and endothelin-1 (ET-1), but the changes were significantly slower in the groups subjected to NSAIDs. The delay in healing in the presence of indomethacin was characterized on the tenth day by a 4.9-fold higher rate of apoptosis, a 4.6-fold higher level of TNF-α and a 2.7-fold higher expression of ET-1, while the delay in healing by aspirin was manifested by a 5.6-fold higher rate of apoptosis, a 5.5-fold higher level of TNF-α and a 2.9-fold higher expression of ET-1. Our findings are the first to demonstrate that NSAID ingestion leads to up-regulation of apoptotic events that interfere with soft oral tissue repair.