Oral Ulcers Research Articles

Detection of genetic mutations underlying early-onset systemic lupus erythematosus.

We aimed to investigate the presence of monogenic causes of systemic lupus erythematosus (SLE) in our early-onset SLE patients. Fifteen pediatric SLE cases who had early disease onset (≤6 years) were enrolled in this study. All patients fulfilled the Systemic Lupus International Collaborating Clinics (SLICC) criteria. Genomic DNA was used for whole exome sequencing (WES). Pathogenic variants were confirmed by Sanger sequencing. The median age at diagnosis of 15 early-onset SLE patients included in the study was 4 (2-6) years (F/M = 12/3). Significant gene mutations were detected in five of these patients (33.3%). Patients 1 and 2 with homozygous DNASE1L3 mutations [c.320+4_320+7del and G188A (c.563G>C) variants] had skin involvement and oral ulcers. One of them (patient 1) had arthritis and nephritis, and another (patient 2) had nonscarring alopecia and thrombocytopenia. They are currently clinically inactive but have positive serological findings. Patient 3 with homozygous pathogenic ACP5 mutation [G109R (c.325G>A) variant] had arthritis, nephritis, short stature, and skeletal dysplasia. Patient 4 with a heterozygote novel IFIH1 mutation [L809F (c.2425C>T) variant] had skin findings and leukopenia. Patient 5 with novel C1S variant [homozygous C147W (c.441C>G) variant] had marked skin findings, oral ulcers, nonscarring alopecia, pancytopenia, and low total hemolytic complement CH50 level. All patients have responded to the treatments and have low Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores, on therapy. Genetic causes should be investigated in early-onset SLE, for better management and genetic counseling. On the other hand, multicenter studies may help to further define genotype-phenotype associations.

Clinical Profile and In-hospital Outcome of Acute Household Substances Poisoning in a Tertiary Care Hospital

Background: Poisoning is an acute medical emergency. Among the thousands of harmless products available for household, very few are hazardous. Still, self-poisoning with these substances is one of the commonest mode of poisoning. This study was carried out to get information related to clinical profile and inhospital outcome of household substances poisoning in a particular area of Bangladesh. Methods: This cross-sectional type of descriptive study was carried out in the department of Medicine, Sylhet M.A.G. Osmani Medical College Hospital, Sylhet, Bangladesh during the period of June 2022 to November 2022.Purposive convenient sampling was applied to recruit sample from study population. Calculated sample size was 64. Detailed history including nature of poisoning (unintentional/ intentional), route of poisoning, type of poison, symptoms and signs with relevant laboratory findings were documented in a structured data collection sheet through interview from the patient or their guardians after obtaining informed written consent. In-hospital outcome in terms of survival (discharged, discharge without advice/absconded) and mortality were recorded.Results:Among 64 participants majority 65.63% (n=42) were female and most 56.25% (n=36) were of 18-20 years age group.Regarding educational status 96.87 %(n=62) participants were educated. All of the poisoning were intentional and by oral route. Harpic was the most common agents 59.38% (n=38) used by the victims.Vomiting was the most common 81.25% (n=52) symptomand oral ulcer was the commonest 40.63% (n=26) sign. No significant abnormality of vital signs and laboratory investigations were found. Majority of the respondents 43.75 % (n=28) stayed 2 days in hospital for treatment purpose. Total 85.94% (n=55) respondents were discharged with advice and 14.06% (n=9) respondents left hospital without medical advice. No death was documented in this study. Conclusion: Young teenaged female patients were the majority of victims in our study reflecting the degree of powerlessness and hopelessness of young, educated people with unemployment and difficulties in coping with life stressors. Bangladesh J Medicine 2024; 35: 70-75

Experimental design approach for the quantitative analysis of multicomponents by single marker and HPLC fingerprinting of Thunbergia laurifolia aqueous extract.

Thunbergia laurifolia is used in traditional Thai medicine to reduce fever and treat mouth ulcers. However, the quantitative analysis of chemical markers has not yet been officially defined. The objective of this study is to develop a high-performance liquid chromatography (HPLC) method using a design of experiment (DoE) for the quantitative analysis of multicomponents by single marker (QAMS) and fingerprinting of the T. laurifolia aqueous extract. Critical variables were screened using a two-level fractional factorial design, followed by the optimization of the selected variables using a central composite design. The validated method was applied for quality assessment based on QAMS and fingerprinting of the extract. Optimum conditions of DoE for the analysis of caffeic acid, vicenin-2, and rosmarinic acid were determined. The relative correction factors for caffeic acid and vicenin-2 were calculated using rosmarinic acid as an internal reference standard, and their contents in 30 samples were determined. The differences between the external standard method (ESM) and QAMS were compared. No significant difference was observed in the quantitative determination, proving the consistency QAMS and ESM. HPLC fingerprints of T. laurifolia were established with 8 of 12 characteristic peaks that were structurally characterized using HPLC-diode array detection-electrospray ionization/tandem mass spectrometry. The similarity of the fingerprints in all samples was ≥0.74, and the pattern recognition of the characteristic peaks was satisfied. The proposed method efficiently detected multiple components of the T. laurifolia extract. Thus, the method is beneficial in providing references for enhancing the quality control of other herbal medicines.

Current understanding of ELF4 deficiency: a novel inborn error of immunity.

ELF4 deficiency has been recently recognized as a novel disorder within the spectrum of inborn errors of immunity (IEIs), specifically categorized as a "disease of immune dysregulation." Cases of this condition, reported by our team and others, are very limited worldwide. As such, our current knowledge of this new disease remains preliminary.This review aims to provide a brief overview of the clinical manifestations, pathogenesis, and treatment strategies for this novel IEI. A comprehensive review was conducted after an extensive literature search in the PubMed/Medline database and websites concerning transcriptional factor ELF4 and reports concerning patients with ELF4 deficiency. Our search strategy was "ELF4 OR ETS-related transcription factor Elf-4 OR EL4-like factor 4 OR myeloid Elf-1-like factor" as of the time of manuscript submission. The current signature manifestations of ELF4 deficiency disorder are recurrent and prolonged oral ulcer, abdominal pain, and diarrhea in pediatric males. In some cases, immunodeficiency and autoimmunity can also be prominent. Targeted Sanger sequencing or whole exome sequencing can be used to detect variation in ELF4 gene. Western blotting for ELF4 expression of the patient's cells can confirm the pathogenic effect of the variant. To fully confirm the pathogenicity of the variant, further functional test is strongly advised. Glucocorticoid and biologics are the mainstream management of ELF4 deficiency disorder. Pediatric males presenting with recurring ulcerations in digestive tract epithelium with or without recurrent fever should be suspected of DEX. When atypical presentations are prominent, variations in ELF4 gene should be carefully evaluated functionally due to the complex nature of ELF4 function. Experience of treating DEX includes use of glucocorticoid and biologics and more precise treatment needs more patients to identify and further mechanistic study.

Clinical and laboratory profiles of systemic lupus erythematosus patients in a new rheumatology clinic in southwestern Nigeria

IntroductionThe aims were to study the sociodemographic characteristics of patients presenting to the clinic and to study the clinical and serological pattern of systemic lupus erythematosus (SLE) in a new rheumatology clinic of a predominantly Yoruba population.Material and methodsThis was a retrospective, cross-sectional study conducted over 7 years (January 2017 – December 2023). Patients who satisfied the 1997 American College of Rheumatology (ACR) and/or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria were enrolled using their medical records. Patients with overlap syndromes and other inflammatory or noninflammatory rheumatic diseases were excluded from the study. Their sociodemographic, clinical, laboratory, and treatment data were retrieved from their medical records and analysed using IBM SPSS version 23.0 software.ResultsA total of 65 patients were diagnosed with SLE with a frequency of 15.8%. The mean age ±SD of the patients at presentation was 33.85 years ±11.01 and the female to male ratio was 9.8 : 1. The median (IQR) duration of symptoms at presentation was 7.0 months (3–24). The common clinical presentations included synovitis (86.2%), acute cutaneous rash (53.8%), oral ulcers (52.3%), nonscarring alopecia (50.8%), and serositis (47.7%). Proteinuria was seen in 37.7% of the patients and the predominant renal histopathological feature was Class IV. Antinuclear antibody was 100% positive with 50.94% of the patients having a titre of 1 : 5,120 and above. Anti- double-stranded deoxyribonucleic acid and anti-Smith antibodies each had 50% prevalence. Dyslipidaemia was found in 76.7% of the patients.ConclusionsThe study’s findings are largely consistent with similar studies done in Africa. Further prospective multi-centred studies are needed to further determine the epidemiological characteristics of the disease in Nigeria with a multi-ethnic population.

Taste alteration and its relationship with nutritional status among cancer patients receiving chemotherapy, cross-sectional study

The aim of this study is to determine the prevalence of taste alterations (TAs) during chemotherapy and their association with nutritional status and malnutrition. In addition to the associated factors with TA, including sociodemographic health-related factors and clinical status, and to investigate coping strategies to manage TA. A multicenter cross-sectional design study was conducted on 120 cancer patients aged at least 18 who had been undergoing at least one round of chemotherapy. TAs were evaluated using the chemotherapy-induced taste alteration scale (CiTAS), the malnutrition universal screening tool (MUST) was used for nutritional screening, the antineoplastic side effects scale (ASES) was used for subjective assessment of chemotherapy side effects, and the Charlson comorbidity index (CCI) was used for comorbidity assessment. SPSS21 software was used to analyze the data, and the independent T-test and one-way ANOVA test were used to determine the association between TAs and a variety of related variables. The prevalence of TAs was 98.3%. Among participants, 48.3% were at low risk of malnutrition, 20% at medium risk, and 31.7% at high risk. Malnutrition risk was associated with taste disorders (p<0.05). Patients’ age, gender, educational level, and physical status were associated with TAs (p<0.05). Type of cancer, chemotherapy regimen, and number of chemotherapy cycles were also associated with TAs (p<0.05). A variety of antineoplastic side effects were associated with TAs (p<0.05), including nausea, vomiting, dry mouth, sore mouth and throat, excessive thirst, swallowing difficulty, appetite changes, weight loss, dizziness, lack of energy, disturbed sleep, anxiety, and difficulty concentrating. TAs were associated with an increased number of comorbidities, and individuals with diabetes, pulmonary diseases, and hypertension were associated with TAs (P<0.05). Patients in this study rarely practice self-management strategies to cope with TAs. A high prevalence (98.3%) of TAs in cancer patients receiving chemotherapy was found, and it was linked to a variety of negative outcomes. Chemotherapy-induced TAs are an underestimated side effect that requires more attention from patients and health care providers.

A Tough Janus Hydrogel Patch with Strong Wet Adhesion and Self-Debonding for Oral Ulcer Treatment

A Tough Janus Hydrogel Patch with Strong Wet Adhesion and Self-Debonding for Oral Ulcer Treatment

Antibacterial, Trichomonacidal, and Cytotoxic Activities of Pleopeltis crassinervata Extracts

Pleopeltis crassinervata is a fern documented in ethnobotanical records for its use in Mexican traditional medicine to treat gastric disorders and mouth ulcers. Consequently, conducting biological and pharmacological assays is crucial to validate the therapeutic efficacy of this plant within the context of traditional medicine. In the present study, we investigated the biological activity of extracts and fractions obtained from P. crassinervata organs against bacteria (Salmonella typhimurium, Salmonella typhi, Staphylococcus aureus, Proteus mirabilis, Shigella flexneri, Bacillus subtilis, Escherichia coli) and Trichomonas vaginalis using in vitro models. The precipitate fraction obtained from the frond methanolic extract showed significant antibacterial activity (minimal inhibitory concentration [MIC] 120 µg/mL) against the Staphylococcus aureus strain and was effective against both Gram-positive and Gram-negative bacteria. The hexane fraction also obtained from frond methanolic extract, showed a trichomonacidal effect with an IC50 of 82.8 μg/mL and a low cytotoxic effect. Hsf6 exhibited the highest activity against T. vaginalis, and the GC-MS analysis revealed that the predominant compound was 16-pregnenolone. The remaining identified compounds were primarily terpene-type compounds.

Mandibular Osteomyelitis as the Earliest Clinical Manifestation of Maxillary Sinus Lymphoma.

Extranodal natural killer/T-cell lymphoma is a distinct subtype of non-Hodgkin lymphoma that originates from natural killer cells or cytotoxic T cells. Its diagnosis is challenging due to the rarity and lack of awareness, especially in cases where osteomyelitis of the jawbone is the initial symptom. This paper reports a case of extranodal natural killer/T-cell lymphoma presenting primarily with oral ulcers. Through analyzing the clinical and pathological characteristics, differential diagnosis, treatment and prognosis, and reasons for misdiagnosis of the disease, this study aims to provide references for clinical diagnosis and treatment.

Epstein-Barr virus-related lymphoproliferative disorders of the skin

Epstein Barr Virus (EBV) is associated both solid (nasopharyngeal carcinoma, non-nasopharyngeal lymphoepithelioma- like carcinoma, gastric carcinoma, leiomyosarcoma) and hematolymphoid malignancies, some of the latter, however, spanning over a spectrum ranging from reactive and self-limiting to severe and life-threatening conditions. This review will focus on the disorder most commonly involving the skin, namely: EBVpositive mucocutaneous ulcer; lymphomatoid granulomatosis; EBV-positive diffuse large B cell lymphoma; plasmablastic lymphoma; post-transplant lymphoproliferative disorder; extranodal NK/T cell lymphoma, nasal type; angoimmunoblastic T cell lymphoma; severe mosquito bite allergy; hydroa vacciniformelike lymphoproliferative disorder. Given the uncommon occurrence of all these infiltrates in the skin, multidisciplinary approach, as well as referral to tertiary care centers are always advisable.

Examination of Ulcero-Proliferative Lesions of Oropharynx and Oral Cavity- A Clinical Perspective

 Introduction Patients often present with ulcero-proliferative lesions of the oropharynx and oral cavity in the outpatient department (OPD). These lesions have a negative impact on the patients' health, so it's critical to make an accurate diagnosis and administer the right care.  Aim of the Study: To determine the proportion of patients who exhibit different ulcero-proliferative lesions clinical characteristics in the oropharynx and oral cavity.  Patients and Methodology: This is prospective study done at Department of ENT, Guntur Medical College, spanning a period of 18 months. This study included patients with ulcero- membranous lesions in the oropharynx and oral cavity, regardless of age. This study excluded Patients who had radiation therapy soon before developing the illness and who had traumatic injuries but no infection. Detailed history including personal, family and medical history were noted. Local and general examination was done. Selected patients were subjected to investigations like routine blood investigations, gram stain, albert’s stain, KOH mount, culture and sensitivity, peripheral smear, serology, FNAC, HPE, USG, chest x ray, CT neck, MRI.  Results In the current study, men dominated women (65.69%) and the most prevalent age group participating was 41–60 years old (45.09%). The most typical symptoms of the throat were odynophagia, burning sensation, dysphagia, and throat pain. 5.9% of the patients had nose issues and 14.7% had associated ear complaints. General symptoms included fever in 10.7% of cases, weight loss in 23.5%, general weakness in 15.6% of cases, and skin lesions in 6.9% of cases. Systemic disorders such as HIV was present in 3.9%, hypertension in 25.4%, and diabetes in 34.3% of cases. Risk factors include chewing tobacco (17.6%), drinking alcohol (14.7%), smoking (43.1%), and having previously been exposed to radiation (0.9%). The tongue was the most frequently afflicted site in this study (44.1%), followed by the palate (29.4%), the buccal mucosa (15.6%), the tonsils (8.8%), the lips (7.8%), the alveolus (2.9%), and the RMT (1.9%). Neoplastic etiology accounted for 41.1% of the total etiology discovered. It was followed by inflammatory (31.3%), infectious (20.5%), and miscellaneous (6.8%) etiologies. 52.9% of patients had conservative care, 36.2% had oncosurgery team treatment through surgery, and 10.7% had radiation therapy. Of the patients with neoplastic etiology, 10.7% had radiation therapy.  Conclusion: The incidence of cancers rises in the adult population with increased habits like smoking and chewing nicotine in any form. A high degree of suspicion is required when treating oral ulcers, particularly those that are chronic. The gold standard for confirming the diagnosis is always a biopsy and a histopathological examination.

Healing activity of a muco-adhesive formula of Teucrium polium against acetic acid-induced oral ulcer in rats

Oral ulcers are highly common painful conditions that harmfully affect the quality of life and require long-term therapy. Muco-adhesive preparations provide efficient and convenient delivery systems that prolong the drug retention time necessary for the different stages of ulcer healing. Therefore, the study aimed to evaluate the healing activity of Teucrium polium in a muco-adhesive formula against acetic acid-induced oral ulcers in rats. Acetic acid was applied to the inner cheeks of the rats and the muco-adhesive formula was applied once daily for 14 days. Acetic acid was found to disrupt the oral tissue histological features, increase collagen deposition, induce oxidative stress through increasing malondialdehyde (MDA) levels and decreasing superoxide dismutase and catalase activities, increase the expression of the inflammatory biomarkers, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), cyclooxygenase-2 (COX-2), and decreased hydroxyproline content and the expression of the factors that contribute in wound healing including transforming growth factor-beta1 (TGF-β1), vascular endothelial growth factor receptor 1 (VEGFR1), and platelet-derived growth factor receptor beta (PDGFRβ). However, the daily application of a mucoadhesive formula impregnated with T. polium, significantly restored the regular histological features of the oral tissue, decreased the concentration of MDA, TNF-α, IL-6, and COX-2, increased superoxide dismutase and catalase activities, and restored the expression of TGF-β1, VEGFR1, and PDGFRβ. Therefore, T. polium extract muco-adhesive formula can be considered a potential therapy for chronic oral ulcers.

Prevalence, types, and characteristics of headache in Behcets disease without involvement of the central nervous system in the Syrian population: a case-cohort study.

Oral ulcers, genital ulcers, and uveitis represent the typical trial of Behcet's disease (BD). It is well common on the Old Silk Road. The mucocutaneous lesions are the hallmark of BD, but neurological involvement is one of the severe symptoms. Headaches may be an early sign of BD neurological involvement. This study aims to investigate the headache prevalence and its types, and characteristics in a Syrian sample of BD patients. BD patients were clinically interviewed and examined to collect their information, symptoms, and signs. the International Study Group for Behcet's Disease diagnosis criteria was used to confirm the BD diagnosis. The International Classification of headaches was used when classifying the headaches. One hundred twenty participants were included in the study. half of them were BD patients and the control group was also 60 participants. Among Syrian BD patients, 36.7% suffer from primary headaches and 36.7% suffer from secondary headaches. These findings were not significantly different between the BD patients and the healthy population. Our results showed that there was no statistically significant difference between the two groups. Headache should not be considered a predictor for neurological involvement among BD patients. Additional attention to BD patients or the specific treatment for headaches is not required and does not differ from the general population.

Amikacin induced Stevens Johnson syndrome and toxic epidermal necrolysis overlap: a rare case report

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the most severe adverse drug reactions. They are characterized by necrosis and epidermal release in vesicobulosa skin, mucous orifice, and eyes, with more severe general symptoms. SJS/TEN-overlap syndrome is the term used to characterize situations where 10–30% of the body skin area is detached. TEN or SJS is one of the deadliest dermatological catastrophes. Despite being a rare condition, it frequently has a high death rate. Different types of purpuric macules or rounded patches with mucosal lesions are characteristic features of these type 3 hypersensitivity reactions. We are presenting a case of 50-year-old female patient brought to hospital on account of multiple black to red coloured raised lesions over body in the last 8 days. Patient was asymptomatic in the last 8 days after that patient noted red coloured lesions first over face followed by lower back, upper limb, lower limb followed by itching and Jiburning sensation all over the body. The patient had symptoms such as redness of eyes in the last 3-4 days, burning sensation and ulcers in mouth in the last 3-4 days. These symptoms developed day after she received amikacin. She was diagnosed with SJS-TEN overlap. This case highlights the precipitant of antibiotics for SJS. She was recovered completely after stopping the causative drug and treatment with Immunoglobulin with other symptomatic measures. The causative drug was found to be Amikacin and medicine taken for comorbid conditions like epilepsy, hypothyroidism and hypertension. Rarely, amikacin has been linked to a range of drug hypersensitivity reactions, including toxic epidermal necrolysis, Stevens-Johnson syndrome, and overlap between the two conditions.

Examining the role of salivary IL-2 and IL-22 in recurrent aphthous stomatitis: a diagnostic approach

Background: Recurrent aphthous stomatitis (RAS) is a prevalent inflammatory condition, that manifests as mouth ulcers. This study aims to evaluate IL-2 and IL-22 levels in saliva samples of individuals with recurrent aphthous stomatitis (RAS) compared to healthy volunteers. Methods: A case-control study was conducted between April 1st and September 30th, 2023, at the Dental Center of New Baquba, Diyala, Iraq. Saliva samples were collected from 40 patients diagnosed with recurrent aphthous stomatitis and 40 healthy controls. IL-2 and IL-22 levels were assessed in both groups using enzyme-linked immunosorbent assay (ELISA). Statistical analysis, employing paired sample ‘t’ test, was conducted with a significance threshold below. Results: In the case group, the mean age was 53.4 years (SD=1.58), ranging from 26 to 81 years, while in the control group, it was 47.18 years (SD=1.55), ranging from 24 to 78 years. Females predominated in both groups, comprising 62.5% in cases and 52.2% in controls. Most aphthous ulcers (77.5%) were found in the buccal mucosa, with minor aphthous ulcers being the most common (67.5%). Results from paired-samples t-tests revealed significantly higher levels of IL-2 in RAS cases (M=62.090, SD=20.242) compared to controls (M=36.366, SD=14.596), (t(39)=7.101, p < 0.001). Similarly, IL-22 levels were significantly elevated in RAS cases (M=106.537, SD=44.112) compared to controls (M=73.399, SD=32.852), (t(39)=3.553, p=0.001). These results suggest a potential association between RAS and increased IL-2 and IL-22 levels, indicating their involvement in RAS pathophysiology. Conclusion: In summary, females showed a significant predominance in RAS cases. Significant differences were observed in IL-2 and IL-22 levels between case and control groups.

Complex connective tissue convergence: A case report of scleroderma, systemic lupus erythematosus, and Sjögren's Syndrome overlap syndrome in an adolescent female

This case report illustrates the uncommon occurrence of an overlap syndrome involving systemic sclerosis (SSc), systemic lupus erythematosus (SLE), and Sjögren's syndrome in a 16-year-old female patient. Despite their distinct pathophysiological mechanisms and clinical manifestations, these connective tissue diseases converged in this patient, presenting a diagnostic challenge. The clinical presentation included features such as Raynaud's phenomenon, mouth and digit ulcers, alopecia, photosensitivity, and positive autoantibodies. Diagnostic workup revealed positive findings on antinuclear antibodies (ANA) and extractable nuclear antigen (ENA) panel, confirming the presence of autoantibodies associated with all three conditions. The patient was managed with a combination of symptomatic treatment, hydroxychloroquine, and prednisolone. This case underscores the complexity of overlapping autoimmune diseases and emphasizes the importance of a thorough clinical evaluation, appropriate diagnostic testing, and timely initiation of management to optimize patient outcomes.

Impact of Thermo-Responsive N-Acetylcysteine Hydrogel on Dermal Wound Healing and Oral Ulcer Regeneration.

This study investigates the efficacy of a thermo-responsive N-acetylcysteine (NAC) hydrogel on wound healing and oral ulcer recovery. Formulated by combining NAC with methylcellulose, the hydrogel's properties were assessed for temperature-induced gelation and cell viability using human fibroblast cells. In vivo experiments on Sprague Dawley rats compared the hydrogel's effects against saline, NAC solution, and a commercial NAC product. Results show that a 5% NAC and 1% methylcellulose solution exhibited optimal outcomes. While modest improvements in wound healing were observed, significant enhancements were noted in oral ulcer recovery, with histological analyses indicating fully regenerated mucosal tissue. The study concludes that modifying viscosity enhances NAC retention, facilitating tissue regeneration. These findings support previous research on the beneficial effects of antioxidant application on damaged tissues, suggesting the potential of NAC hydrogels in improving wound care and oral ulcer treatment.

Trapped neutrophil syndrome in a young Border Collie dog: A new clinical presentation

AbstractAn 11‐month‐old Border Collie dog presented with recurrent fever since the age of 3 months. Clinical examination revealed stunted growth, facial dysmorphism, fever, oral and third eyelid ulcerations and stiff gait with tarsal hyperlaxity. Clinicopathologic testing revealed neutropenia with normal neutrophil maturation in the bone marrow, ulcerative neutrophilic stomatitis and glossitis and a nonperforating duodenal ulcer. Genetic testing showed a mutation in the vacuolar protein sorting‐associated protein 13B gene, establishing a diagnosis of trapped neutrophil syndrome. Steroid therapy was not prescribed due to the presence of a duodenal ulcer. Two weeks later, antibiotics and omeprazole facilitated a mild clinical improvement with relapse; euthanasia was subsequently elected. This case highlights clinical signs not previously described in dogs but known in humans with Cohen syndrome, including buccal ulcerations or joint hyperlaxity. This is also the first description of this disease in France, where Border Collies are commonly bred.

Mucocutaneous Ulcers Unmasking Severe Systemic Methotrexate Toxicity – A Case-Series and Review of Literature

Abstract Background: Methotrexate is a widely used immunosuppressant with good efficacy and cost-effectiveness. However, one of the drawbacks of methotrexate has been toxicity due to accidental overdose. During the COVID pandemic, there was an alarming increase in the number of patients with methotrexate toxicity which prompted us to do this study. Objective: To evaluate the clinical features and contributing factors in patients presenting with methotrexate toxicity. Materials and Methods: A detailed evaluation of the clinical features, laboratory indices, contributing factors, and outcomes of the patients presenting with methotrexate toxicity was analyzed. Results: A total of 19 cases were seen during the study period. All of the patients had oral mucositis and several developed cutaneous ulcerations. Laboratory abnormalities included cytopenia, transaminitis, and renal impairment. While sixteen patients recovered successfully, three people died as a result of delays in medical assistance. In addition to comorbidities, pandemic-induced restrictions played a major role in patients accidentally overdosing with methotrexate. Conclusion: This study highlights the fact that even low-dose methotrexate taken incorrectly can result in a lethal outcome, which is preventable.

Psoriasiform Drug Eruption Associated with Carbamazepine

Behçet’s disease (BD) is a chronic systemic inflammatory vasculitis of unknown etiology characterized by recurrent episodes of oral aphthous ulcers, genital ulcers, skin lesions, ocular lesions, and other manifestations. This disease affects many organs and systems and shows a wide range of clinical manifestations. The prevalence of anxiety, depression, and general psychiatric symptoms is higher among patients with BD compared with healthy individuals. However, syndromes such as psychosis appear to be less frequent. Therefore, we present a case of BD complicated by schizophrenia-like symptoms.