Drug-induced oral erythema multiforme: A diagnostic challenge.

Trimethoprim-sulfamethoxazole (cotrimoxazole or TMP/SMX) is commonly used for the treatment of urinary or lower respiratory tract infections. A comprehensive review is presented of the world literature on adverse reactions to TMP/SMX since its first use in 1968, when concern was expressed about possible hematologic toxicity. The adverse reactions to TMP/SMX occur in approximately 1%-3% of persons in general population. Here, we report a case of oral erythema multiforme (EM) secondary to TMP/SMX that presented with oral and lip ulcerations typical of EM without any skin lesions and highlights the importance of distinguishing them from other ulcerative disorders involving oral cavity. The patient was treated symptomatically and given tablet prednisolone. The condition improved with stoppage of TMP/SMX therapy. It has been reported that primary attacks of oral EM is confined to the oral mucosa, but the subsequent attacks can produce more severe forms of EM involving the skin. Hence, it is important to identify for early diagnosis and management. Although EM is quite common with TMP/SMX, there are no reports of oral EM appearing after intake of this drug.

A review of artifacts in histopathology.

Histopathological examination is considered as gold standard procedure for arriving at a final diagnosis of various lesions of the human body. However, it is limited by a number of alterations of normal morphologic and cytological features that occur as a result of presence of artifacts. These artifacts may occur during surgical removal, fixation, tissue processing, embedding and microtomy and staining and mounting procedures. They can even lead to complete uselessness of the tissue. It is therefore essential to identify the commonly occurring artifacts during histopathological interpretations of tissue sections. This article reviews the common artifacts encountered during slide examination alongside the remedial measures which can be undertaken to differentiate between an artifact and tissue constituent.

Comparison of palatal rugae patterns in Kodava and Malayalee populations of South India.

INTRODUCTION: The palatal rugae pattern is unique to humans and may be specific to ethnic groups hence useful in population identification in forensic dentistry. The present study has been carried out to analyze the rugae pattern in two populations in and around Coorg, with objectives to analyze the palatal rugae pattern among Kodavas and Malayalees and to analyze the rugae pattern between sexes within each group. MATERIALS AND METHODS: The sample comprised two population groups in Coorg namely Kodavas and Malayalees, (n = 30) from each group, age-range of 18-30 years, equally distributed between the sexes. The rugae pattern were categorized as 'straight,' 'wavy,' 'curved' 'circular', and 'unification'. Pairwise comparison for two populations was done using non-parametric Mann-Whitney test. Mann-Whitney two-tailed test was used to test the difference between sexes. RESULTS: Wavy pattern (100%) was highest among Kodavas. There was a significant difference between Malayalees and Kodavas for wavy (Mean = 5.867 and 8.400) and unification patterns (Mean = 2.267and 1.000). Significant difference between sexes for straight rugae pattern (Mean, males = 2.267, females = 1.200) among Malayalees was seen. CONCLUSION: The differences in rugae shape between the two populations (wavy and unification patterns) may be attributed to genetic factors and recent shared ancestry has probably rendered their differences to moderate levels.

Clinical evaluation of total and lipid bound sialic acid levels in oral precancer and oral cancer.

AIMS: Special attention has been given to define the biochemical changes in cell-surface glycoproteins and glycolipids that take place during malignant transformation. This study was thus designed to explore the clinical utility of total and lipid bound sialic acid (LSA) in patients with oral precancer and oral cancer. MATERIALS AND METHODS: Blood samples were obtained from 95 subjects divided into three groups, namely healthy individuals, oral cancer, and precancer. Serum total and LSA levels were determined using periodate-thiobarbituric acid method and Katopodis et al. method, respectively. Finally, spectrophotometricreadings were obtained. RESULTS: Mean values of serum sialic acid (total and lipid bound) in oral cancer were significantly higher than control and the precancer group (P<0.001). The multivariate analysis data revealed progressive rise in total and LSA, which was statistically significant with clinical stage of the cancer. CONCLUSION: Serum sialic acid levels can differentiate between patients with oral precancer and oral cancer. It could be used as an adjunct to diagnosis, monitor response to therapy, and assess the staging of cancer.

Trimethoprim-sulfamethoxazole-induced Steven Johnson syndrome in an HIV-infected patient.

Trimethoprim-sulfamethoxazole (TMP/SMX) is a widely prescribed antimicrobial for the management of several uncomplicated infections. It is commonly used for the treatment and prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in the HIV-infected population. The adverse reaction to TMP/SMX is more frequent and severe in HIV-infected patients as compared to the general population. Here, we report a case of Stevens-Johnson syndrome (SJS) secondary to TMP/SMX. The patient had a generalized cutaneous reaction with involvement of the eyes, oral cavity, and genitals. He had elevated hepatic alanine aminotransferase and aspartate aminotransferase enzyme. TMP/SMX therapy was stopped and supportive treatment was started. His condition improved after eight days of stopping TMP/SMX therapy.