Home Dental Radiology Chronic symptomatic oral ulcers – The Journal of the American Dental Association

Chronic symptomatic oral ulcers – The Journal of the American Dental Association

by adminjay

A 53-year-old woman reported chronic symptomatic gingival and oral lesions exacerbated
by spicy and acidic foods of 6 months’ duration. The patient had been evaluated previously
for these problems by 8 medical and dental providers and was treated with triamcinolone
0.1% paste, doxycycline, nystatin rinse, clotrimazole troches, valacyclovir, and topical
anesthetic rinse, all without benefit. Her medical history was significant for celiac
disease and cervical radiculopathy. Surgical, family, and social histories were unremarkable.
Medications included ketolorac 0.4% ophthalmic solution and prednisolone acetate 1%
ophthalmic solution. The patient reported type 1 allergies to cefaclor and penicillin.
The review of systems was pertinent for acid reflux. Extraoral examination revealed
a well-nourished woman without evidence of lymphadenopathy, salivary gland enlargement,
or thyromegaly. Intraoral examination revealed diffuse erythema, lacelike striae,
and ulcerations on the buccal mucosa bilaterally, tongue, and floor of the mouth (
Figure 1). In addition, erythema and focal areas of desquamative gingivitis affecting the
maxillary and mandibular gingivae were observed (
Figure 2). Incisional biopsies of the right buccal mucosa were performed for hematoxylin and
eosin staining and direct immunofluorescence analysis (DIF). Routine histology revealed
hyperkeratotic, acanthotic, stratified squamous epithelium exhibiting degeneration
of the basal cell layer with a dense bandlike infiltrate of lymphocytes immediately
subjacent to the epithelium (
Figure 3). DIF of perilesional tissue revealed intranuclear immunoglobulin (Ig) G deposition
in the basal and parabasal nuclei without specific or significant staining seen with
antibodies to IgA, IgM, C3, or fibrinogen (
Figure 4).

Figure 1
Lacelike striae, erythema, and ulceration of the right buccal mucosa.

Figure thumbnail gr2

Figure 2
Erythema of the maxillary anterior gingiva.

Figure thumbnail gr3

Figure 3
Lichenoid inflammation at the interface between the epithelium and lamina propria
(hematoxylin and eosin, magnification X40).

Figure thumbnail gr4

Figure 4
Direct immunofluorescence analysis revealed epithelial cell nuclei in the basal and
parabasal region (arrows) demonstrating the speckled pattern of antihuman immunoglobulin
G antibody.

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