Severe Oral Lesions Research Articles

Powder diet exacerbates oropharyngeal candidiasis in a mouse model.

This study reports on the influence of a powder diet in a mouse model of oropharyngeal candidiasis (OPC), a significant health concern caused primarily by Candida albicans. Despite identical nutritional composition, we found that a powdered diet significantly increased Candida burdens and oral lesions, and aggravated weight loss compared to a standard pelleted diet. High fungal burdens and severe oral lesions were accomplished within 48 hours after infection with only one dose of cortisone. Moreover, mice on a powder diet recovered a week after infection. Using a powder diet, we thus modified the cortisone OPC murine model in a way that simplifies the infection process, enhances reproducibility, and facilitates studies investigating both pathogenesis and recovery processes. Our findings also underscore the pivotal role of the physical form of the diet in the progression and severity of oral Candida infection in this model. Future research should investigate this relationship further to broaden our understanding of the underlying mechanisms, potentially leading to novel prevention strategies and improved disease management.IMPORTANCEOropharyngeal candidiasis (OPC) is a multifactorial disease and a significant health concern. We found that the physical form of the diet plays a critical role in the severity and progression of OPC. We developed a modified cortisone OPC murine model that facilitates studies investigating pathogenesis and recovery processes.

Treatment of a Patient with Severe Rash Pain Secondary to Monkeypox Virus: A Case Report

BACKGROUND: The following case describes a multimodal analgesic approach for pain control in a patient with monkeypox (mpox) lesions. CASE REPORT: A 48-year-old man presented with a positive mpox test, an inability to tolerate solid foods due to severe throat pain and painful oral lesions, and severe genital burning and rectal pain. The pain management team utilized a multimodal analgesia regimen, which included a viscous lidocaine mouth solution, lidocaine jelly for perineal pain, acetaminophen, ketorolac, gabapentin, and oxycodone. On the following day, he was able to tolerate solid food and reported significantly less pain with defecation and urination. CONCLUSION: This case report introduces an effective multimodal approach for pain control of mpox related lesions, which utilizes viscous and/or jelly lidocaine, acetaminophen, gabapentin, nonsteroidal antiinflammatory drugs, such as ketorolac, and opioids, such as oxycodone. KEY WORDS: Anorectal pain, Mpox, multimodal analgesia, oropharyngeal pain, rash

SARS-CoV-2 infection causes periodontal fibrotic pathogenesis through deregulating mitochondrial beta-oxidation

The global high prevalence of COVID-19 is a major challenge for health professionals and patients. SARS-CoV-2 virus has four structural protein components: the spike protein, envelope protein, membrane protein, and nucleocapsid protein. The SARS-CoV-2 virus mutates predominantly in the spike proteins, whilst the other key viral components usually remain stable. Essentially the pathological functions of the SARS-CoV-2 virus on different cell types are still largely unknown. Previous studies have shown that the human oral cavity can potentially act as reservoir of the SARS-CoV-2 virus. However, the consequence of SARS-CoV-2 viral infection on human oral health has not been systematically examined. COVID-19 can cause severe oral mucosa lesions and is likely to be connected with poor periodontal conditions. Fibroblasts are the major cell type inside periodontal ligament (PDL) and express the SARS-CoV-2 receptor: Angiotensin-converting enzyme 2 (ACE2), whose expression level can increase upon bacterial infection hence potentially provide a direct route of SARS-CoV-2 infection to PDL fibroblasts. In this research, we aimed to study the pathogenicity of SARS-CoV-2 viral components on human fibroblasts. We found that by exposing to SARS-CoV-2, especially to the viral envelope and membrane proteins, the human periodontal fibroblasts could develop fibrotic pathogenic phenotypes, including hyperproliferation that was simultaneously induced with increased apoptosis and senescence. The fibrotic degeneration was mediated by a down-regulation of mitochondrial β-oxidation in the fibroblasts. Fatty acid β-oxidation inhibitor, etomoxir treatment could mirror the same pathological consequence on the cells, similar to SARS-CoV-2 infection. Our results therefore provide novel mechanistic insights into how SARS-CoV-2 infection can affect human periodontal health at the cell and molecular level with potential new therapeutic targets for COVID-19 induced fibrosis.

Oral manifestations of COVID-19: A review

An important indicator of general health, well-being, and quality of life is oral health. The SARS-CoV-2 virus, which has been discovered to have a number of adverse effects. One of the earliest tissue areas to become infected by the virus and undergo alterations is the oral cavity. Oral manifestations included ulcer, erosion, bulla, vesicle, pustule, fissured or depapillated tongue, macule, papule, plaque, pigmentation, halitosis, white patches, haemorrhagic crust, necrosis, petechiae, swelling, erythema, and spontaneous bleeding. The tongue (38%), labial mucosa (26%), and palate (22%) were the three most typical sites of involvement. Aphthous stomatitis, herpetiform lesions, candidiasis, vasculitis, mucositis, drug eruption, necrotizing periodontal disease, angina bullosa-like, angular cheilitis, atypical sweet syndrome, and Melkerson-Rosenthal syndrome were suggested diagnoses for the lesions. In 68% of instances, oral lesions were symptomatic. There were almost equally as many oral lesions in both sexes (49% female and 51% male). More extensive and severe oral lesions were present in patients who were older and who had COVID-19 diseases that were more severe. The most significant risk factors for the development of oral lesions in COVID-19 patients include poor oral hygiene, opportunistic infections, stress, immunosuppression, vasculitis, and hyper-inflammatory response. It is crucial to identify any changes in the mucosa in COVID-19 patients and administer assertive treatment to prevent complications. Patients should also try to maintain adequate oral hygiene throughout the course of the illness to prevent the colonisation of opportunistic microorganisms and to prevent complications both orally and systemically.

Oral mucosal burn in a neonate due to accidental wart medicine intake

Caustic ingestion is a problem frequently encountered in children younger than five years of age and mostly in developing countries. It may result in eusophagial, laryngeal, orophanryngeal and oral lesions. An 18 day-old-girl brought to emergency room because she was mistakenly given her fathers’s wart medicine instead of her daily vitamin D medicine. There were severe hyperemia and erosions at her lips, oral mucosa and oropharynx. Her oral nutrition was stopped and intravenous protone pump inhibitor drug has initiated. There were no evidence of gastrointestinal perforation at her abdomen X-ray. Her laboratory test results were completely normal. Endoscopic evaluation was not planned at early period because of her severe oral mucosal lesions. She recieved intravenous methylprednisolone for three days.. An eusophagogastroduedonoscopy was performed on day seven and reported to be normal. She has fully recovered without any sequalea. In this article, incorrect drug use and caustic exposure which are one of the most common household accidents were discussed over a newborn case.

Lichen Planus and the Vulvovaginal Gingival Syndrome. Report of a Case and Review of the Literature

<h3>Introduction</h3> Lichen planus is a dermatologic disease that affects both skin and mucosa. Cutaneous lesions of lichen planus present as small polygonal violaceous papules that present most often on the flexor surfaces of the extremities. These lesions may also be present on the vulvar skin and the hair-bearing aspects of the vulva. Lichen planus of the mucous membranes may affect buccal or gingival mucosa and the vulvar vestibule and vagina. Examination of the mouth reveals the white, lacy pattern of hyperkeratotic striae present on buccal mucosa, often bilaterally. The gingiva may be diffusely swollen, erythematous, and exhibit desquamation. In 1982 Pelisse first reported the vulvovaginal gingival syndrome and lichen planus. The main clinical manifestations of the syndrome are a triad of vulvar, vaginal and gingival lichen planus. <h3>Case Report</h3> A sixty-five year old female was referred to the oral surgeon for evaluation of red patches in her mouth. The patient reported that she had a biopsy of her vulvar for which a diagnosis of lichen sclerosis et atrophicus was made. A biopsy of her maxillary gingiva was submitted to the oral pathology laboratory and diagnosed as lichen planus. The vulvar biopsy was sent for comparison. After consultation with Dermatopathology the diagnosis of lichen planus and the vulvovaginal gingival syndrome was made. <h3>Conclusion</h3> We report a case of severe erosive vulvovaginal lichen planus that preceded the onset of gingival lichen planus by nine months. Not uncommonly, patients with severe oral lesions displayed mild genital disease and patients with asymptomatic gingival disease suffered with severe erosive vulvovaginal disease. The diagnosis of vulvovaginal gingival syndrome requires multidisciplinary evaluations by various medical specialists. We have reviewed the literature of this rather rare condition and report an additional case, with the intention of making the practicing clinician aware of this unusual clinical entity.

The SARS-CoV-2 manifestations within the oral cavity

The COVID-19 pandemic that began on 31 December 2019 is considered as the world’s most deadly infectious disease of the century. COVID-19 is predominantly a respiratory disease, but it can really affect any organ in the body. This capability depends on several factors such as the method that is utilised by the virus for cell entry. The virus binds to Angiotens in Converting Enzyme 2 (ACE2) receptors which are present in many cell types and tissues including salivary glands and oral mucosal epithelia [1]. It is therefore not surprising that several tissues in the oral cavity could be a target of SARS-CoV-2 infection. Patients with COVID-19 show wide range of oral manifestations, that has become a major concern for the dental and oral health specialists. The majority of oral health conditions in patients with COVID-19 are: aphthous-like ulcers, herpes-like lesions, fungal infections, glossitis/depapillation/geographic tongue, parotitis and angular cheilitis. These signs and symptoms can be detected in different anatomical subsites of the oral cavity such as oral mucosa, tongue, palate, gingiva and lips [1]. Brandão et al. have shown that older patients with severe form of disease tend to have more severe and widespread oral lesions [2].

Severe uremic stomatitis in a patient with untreated chronic renal failure

A 36-year-old female patient with chronic renal failure was referred by the internal medicine department for severe and painful oral lesions extending to the nasal mucosa. The patient´s medical record revealed that she did not receive dialysis during the last 2 months. Oral examination revealed white hyperkeratotic lesions of the tongue together with a diffuse erythema covered with thick whitish-yellow pseudo membrane. An ulcerated, painful lesion of 3 cm in size was present in the hard palate. Similar lesions were present in the nostrils, especially on the right side. Painful plaques and crusts were also present in both lips. The patient reported severe burning sensation, xerostomia, and halitosis. She was also suffering from loss of appetite, nausea, and dysphagia. Severe weight loss was also noted. Laboratory tests revealed elevated serum creatinine: 711umol/l ( normal 40-115umol), uremia: 32.8mmol/l (normal 2.8-7.2mmol/l), and uric acid 889umol/l (normal 180-420 umol). Protein C reactive was also elevated with 42 mg/l normal

Xeroderma pigmentosum in Yemen

The incidence of xeroderma pigmentosum (XP) in Yemen seems to be quite high but there are no previous reports. To study the clinicoepidemiologic aspect of XP in Yemen. All 40 patients (24 male and 16 female patients from 32 families) treated and followed between 1997 and 2014 were subjected to detailed analysis with the help of a standardized protocol. The diagnosis was based on clinical features and histopathologic data, when needed. The diagnosis of tumors was confirmed by histopathologic examination in all cases. The median age of onset of initial manifestations was 9.5months, and that of malignant lesions was 7years. Parents of the patients were not affected, but history of consanguinity was recorded in 38. Initial lesions, such as dryness of the skin and freckles on the face, were noticed in all patients. In addition, erythema of the face with photosensitivity was observed in 21 patients. Premalignant and malignant skin lesions observed later were actinic keratosis in 15 patients, lentigo maligna in one, squamous cell carcinoma (SCC) in 10, and basosquamous carcinoma in one. Eyes were affected with SCC in seven and malignant melanoma (MM) in two patients. SCC of the lip developed in two patients and that of the tongue in one patient. Judicious use of acitretin in 12 patients showed good result. XP in Yemen is characterized by a relatively high incidence, high percentage of consanguinity in parents of the patients, early onset of initial manifestations, malignant tumors, and severe ocular and oral lesions. Acitretin showed good result.

Hand, Foot and Mouth Disease in Immunocompetent Adult with Severe Oral Manifestation

Abstract Hand-foot-mouth Disease (HFMD) is an acute, self-limited, and highly contagious disease caused by a virus and generally affects children under 10 years old. The etiology of this disease is enterovirus 71 or coxsackievirus A16 which usually causes symptomatic infection or mild disease. Immunocompetent adults are rarely affected. However, recently the incidence of HFMD in immunocompetent adults has increased. We report a 41-year-old woman with severe oral lesions and painful papulovesicular eruption on the palms of her hands and feet.

Effectiveness of Topical Steroids in Treating Herpes-Associated Erythema Multiforme and Review of Topical Steroids Erythema Multiforme and Review of Topical St

50-year-old female presented at the Oral Medicine clinic at the Faculty of Dentistry, Chulalongkorn University, Bangkok with a chief complaint of severe pain in her oral cavity and lips for 1 week. She had no systemic diseases, except for vertigo, and was currently taking cetirizine hydrochloride. An oral examination revealed a hemorrhagic crust on her lips, scaly, large ulcerations on the upper labial mucosa, and multiple oral ulcerations on the right and left buccal mucosa. She had limited mouth opening and difficult in eating. She was treated with benzydamine hydrochloride mouthwash, triamcinolone acetonide 0.1% mouthwash, and fluocinolone acetonide 0.1% solution. The patient’s pain and severe oral lesions gradually reduced after treatment for one week. At the one month follow-up, all lesions had completely disappeared and the laboratory investigation report showed that she was Herpes simplex virus Ab IgG type I and Type II positive; therefore, the diagnosis in this case was Herpes associated erythema multiforme (HAEM). The aim of this case report is to show the effectiveness of various potent topical steroids in treating severe oral ulcerations without any side-effects. Potent topical steroids are recommended as an alternative treatment for severe oral ulcerations in HAEM patients.

Is Simvastatin Associated with Oral Lichenoid Drug Reaction?

Currently, various drugs have been found to induce many oral lesions. Some medications used to treat systemic diseases can affect the oral mucosa and induce lesions known as oral lichenoid drug reaction (OLDR). The diagnosis is made when the oral lesion errupted after the patient took a specific medication. However, diagnosis is challenging when a patient takes multiple medications and the onset of the eruption is unclear. OLDRs commonly cause severe pain in the oral cavity and affect the quality of life. Statins are widely used by patients with cardiovascular disease (CVD) to lower blood cholesterol levels, decreasing the risk of heart attack or stroke. This review will focus the side effects of a hypolipidemic drug group (statins) in the oral cavity. From previous experience, simvastatin may be related to severe oral ulcerations, dysplasia, and carcinoma in situ in the oral mucosa. Moreover, simvastatin combined with amlodipine can induce more severe oral lesions that are very difficult to treat. Therefore, the beneficial effect of these drugs and their side effects should be considered carefully, because simvastatin significantly affects oral and general health.

A Review of the Effectiveness and Side-Effects of Fluocinolone Acetonide 0.1% in the Treatment of Oral Mucosal Diseases.

Topical steroids have been widely used in the treatment of symptomatic oral lesions to reduce pain and inflammation. Potent topical steroids such as clobetasol propionate, fluocinolone acetonide (FA), and fluocinonide have been widely used in the treatment of severe oral mucosal lesions. Many reports have demonstrated that these steroids were effective in treating oral lesions with only minor side-effects. This review describes the effectiveness and side-effects of using FA 0.1% in the treatment of symptomatic oral lichen planus (OLP), oral lichenoid drug reaction (OLDR), oral pemphigus, and herpes associated erythema multiforme (HAEM). FA 0.1% was effective and safe in the treatment of patients with multiple systemic diseases and a pregnant patient with HAEM. Moreover, this topical steroid rapidly reduced pain, inflammation, and enhanced lesion healing with no serious side-effects other than pseudomembranous candidiasis, which is easily treated. In some cases, a long-term treatment with FA 0.1% resulted in hyperpigmentation at the areas of previously healed oral lesions; however, this hyperpigmentation was gradually resolved after discontinuing topical steroid treatment.

An unusual case of rapidly forming severe oral lesions involving bacterial infection in a dog

Abstract The term oronasal fistula refers to an acquired communication between the oral and nasal cavities, and can result from several conditions. However, oronasal fistula formation has not yet been described to be associated with bacterial infections. We have described in this case report for the first time a rapidly forming oronasal fistula and severe lingual lesions in a dog, involving an infection with Streptococcus canis. The patient was a 9-year-old male intact Golden Retriever with a nonspecific history of depression, mild pyrexia, anorexia and retching lasting for two days. Within four days he developed an extensive oronasal fistula, several pseudomembranous erosions, ulcerations and necrotic areas of the tongue and bronchopneumonia. Histopathology of the tongue revealed severe multifocal necrotizing and suppurative subchronic inflammation. Streptococcus canis, Pasteurella multocida, and Staphylococcus pseudintermedius were isolated from the bronchoalveolar lavage and the oronasal fistula. Despite the treatment, the dog developed necrotizing fasciitis and the owners elected euthanasia.

THU0299 IL-1 inhibition in a patient with polymorphism in the interleukin 1-receptor type 1 gene and clinical phenotype of CRMO/DIRA

BackgroundDeficiency of the IL-1 receptor antagonist (DIRA) is an autosomal-recessive disorder caused by mutations of the IL-1 receptor antagonist (IL-1Ra) presenting with systemic inflammation, periostitis, osteolytic lesions, and a pustular...

Methotrexate-induced oral mucositis in rheumatoid arthritis disease: Therapeutic strategy in a case report/Methotrexat-induzierte orale Mukositis bei rheumatoider Arthritis: Therapeutische Strategie in einem Fallbericht

AbstractThe aim of this case report is to evaluate the efficacy of low-level laser therapy (LLLT) in the treatment of oral mucositis induced by methotrexate (MTX).A 52-year-old male patient, affected by rheumatoid arthritis and treated with corticosteroids and MTX, complained about severe oral pain and lesions for two months. He had been treated with topical and systemic corticosteroid therapy and chlorhexidine rinses with no significant improvement. He was not able to eat solid food or to wear his dental prosthesis. Examination of the oral cavity revealed retro-commissural and labial bilateral ulcerations and erythema and a 2-cm wide fibrous white lesion on the lower anterior vestibular ridge. Blood tests showed mild pancytopenia, and oral biopsies evidenced a “non-specific inflammatory condition” excluding any precancerous or paraneoplastic lesion or autoimmune diseases of the oral cavity. Previous medical records revealed that MTX had been discontinued many times due to mucositis since 2006, when the therapy had been started. This suggested a correlation between the onset of oral mucositis and MTX accumulation. LLLT was carried out for 4 consecutive days and three once-a-week follow-ups were performed.Lesions had completely healed during the second follow-up and the patient referred no pain at all from the 4th laser session on, therefore, the discontinuation of MTX had not been necessary.LLLT could represent an innovative technique to relieve pain related to MTX side effects thus avoiding dangerous discontinuation of therapy.

An adult case of severe hand-foot-mouth disease accompanying persistent fever and systemic arthritis

This paper reports a case of adult HFMD with vesicles scattered on the whole body and severe oral lesions. In addition, a long-lasting elevated level of C-reactive protein (CRP) was a feature of this case. Our case is unusual for HFMD with long-lasting joint pain and high fever.

A Case Report:hand-foot Syndrome Accompanied By Severe Oral Lesions During Capecitabine Therapy For Metastatic Colon Carcinoma

A Case Report:hand-foot Syndrome Accompanied By Severe Oral Lesions During Capecitabine Therapy For Metastatic Colon Carcinoma

Caustic esophagitis in two siblings:Munchausen syndrome by proxy

Background and aim: Recurrent corrosive esophagitis is a rare condition among children and may be due to child abuse. The Munchausen Syndrome by Proxy (MSBP) is special form of child abuse with variety of symptoms. It has challenging diagnostic process and needs a high clinical suspicion. When it is identified by physician, institutional child protection team must involve into the management of the case. Case report: We present the two siblings with recurrent esopahigitis. One of them died due to severe gastrointestinal bleeding. Other had severe esophageal stricture and oral lesions. Their mother fed both of them with caustic material at various time intervals. Both babies were treated in our hospital several times with the admission of their mother. Conclusion: This is the probably the first case report of Munchausen Syndrome by Proxy (MSBP) with caustic material ingestion of two siblings. Determining the exact cause of such cases is very difficult and physician must suspect child abuse in this situation.

Immunohistological evaluation of feline herpesvirus-1 infection in feline eosinophilic dermatoses or stomatitis.

This study used immunohistochemistry (IHC) and histopathology to evaluate the presence of feline herpesvirus-1 (FHV-1) in feline cases of 'eosinophilic granuloma complex' (EGC) or other eosinophilic dermatoses or stomatitis, diagnosed at the Veterinary Pathology Diagnostic Service, University of Sydney between January 1996 and June 2008. Two of the 30 cases (6.6%) examined showed positive immunoreactivity to FHV-1 using IHC. Intranuclear inclusion bodies were also detected on histopathological examination of haematoxylin and eosin stained sections of both cases but were very difficult to find. Therefore, FHV-1 is uncommonly associated with EGC or other eosinophilic dermatoses or stomatitis in Sydney. However, misdiagnosis as an EGC lesion or other eosinophilic dermatoses may occur if inclusion bodies are overlooked or absent on histopathology and this may significantly decrease the chance of a favourable treatment outcome. FHV-1 should be considered in cats with severe ulcerative cutaneous or oral lesions, unresponsive to corticosteroid treatment, with or without concurrent or historical signs of upper respiratory tract or ocular disease more typical of FHV-1. IHC may be helpful in differentiating FHV-1 dermatitis or stomatitis from other eosinophilic lesions, which is of vital clinical and therapeutic importance.