Traumatic Ulcerative Granuloma with Stromal Eosinophilia on the Tongue.

BACKGROUND: Traumatic Ulcerative Granuloma with Stromal Eosinophilia, commonly known as Eosinophilic Ulcer, is a reactive solitary and self-limiting benign lesion. It manifests as a punched-out ulcer with a distinct surrounding indurated border, often raising concerns about malignancy. METHODS: A 44-year-old male presented with a painless, indurated tongue ulcer evolving over three months. Despite being asymptomatic, the patient underwent an incisional biopsy due to suspicions of oral squamous cell carcinoma. RESULTS: Histological analysis revealed a disrupted epithelial lining, dense necrotic connective tissue, and a fibrino-purulent pseudomembrane. Proximal to the ulcer, a collar-like projection of reactive epithelial tissue hyperplasia was noted, accompanied by mononuclear cells and a predominantly histiocytic infiltrate in the submucosal layer surrounding skeletal muscle fibers. The final diagnosis was Traumatic Ulcerative Granuloma with Stromal Eosinophilia. Remarkably, the lesion spontaneously healed within 2 weeks post-biopsy, with no recurrence over 6 months. CONCLUSION: This case emphasizes considering this benign condition in the differential diagnosis of oral ulcers, highlighting the importance of accurate histopathological evaluation to rule out cancer.

Can the mucosal attacks of Behçet's disease be predicted?

The primary objective of this study was to investigate the association between disease activity and serum and salivary procalcitonin (Pct) levels in patients with Behçet's disease (BD). The study included patients diagnosed with BD and age-matched healthy volunteers (N: 48, N: 32). Serum and salivary Pct levels were quantified using enzyme-linked immunosorbent assay (ELISA) in the laboratories of Diskapi Yildirim Beyazit Training and Research Hospital. No significant disparity was observed in serum and salivary Pct levels between the patient and control groups (p > 0.05). Furthermore, there was no noteworthy correlation between disease activity and serum and salivary Pct values (p > 0.05). However, the serum Pct level in patients with active oral ulcers was significantly elevated compared to those without active oral ulcers (p: 0.003). Serum Pct emerges as a valuable marker for monitoring oral aphthous ulcer attacks within the patient population.

Erythema multiforme-like lip presentation in pemphigus vulgaris patients: a multicenter case series.

Pemphigus vulgaris (PV) is a chronic autoimmune mucocutaneous blistering disease. Autoantibodies are directed against desmogleins, leading to the formation of intraepithelial bullae. PV, as with other autoimmune mucocutaneous disorders of the oral cavity, presents diagnostic and therapeutic challenges. Approximately 50-70% of cases present first with oral lesions. The lesions commonly start as vesicles or bullae that rapidly rupture, leading to erosions and ulcerations. The palatal, gingival, buccal, and labial mucosa are the most commonly affected sites. Oral PV can mimic several other diseases that cause mucosal erosions and/or ulcerations, including erythema multiforme (EM). EM is an acute, immune-mediated, self-limited hypersensitivity condition primarily associated with herpes simplex infection. Oral lesions can be variable, but a very characteristic presentation with labial hemorrhagic erosions, ulcerations and crusting is commonly seen. In this case series, we present six cases of PV: one male patient and five female patients whose ages ranged from 34 to 65 years old. All patients presented with hemorrhage and crusting of the lips in addition to multiple intraoral erosions and ulcerations. Three patients presented with oral and skin lesions. All patients underwent biopsies, and a diagnosis of PV was confirmed. All patients were treated with steroids (topical and systemic) and variable steroid-sparing agents. This case series emphasizes that oral PV may be misdiagnosed as EM in a subgroup of patients who present with persistent lip hemorrhage and crusting. Therefore, a comprehensive history, clinical examination and incisional biopsies should be considered in such patients.

Oral ulceration (Part 1).

Ulceration is probably the oral mucosal condition seen most frequently by general dental practitioners. It is almost always painful and therefore sufferers are prompt to seek advice. An important exception to this generalisation is the occurrence of oral squamous cell carcinoma, which is often painless in its early stages. Definitive diagnosis, which requires mucosal biopsy, is mandatory for any persistent area of oral ulceration.

Oral ulceration (Part 2).

Ulceration is probably the oral mucosal condition seen most frequently by general dental practitioners. It is almost always painful and therefore sufferers are prompt to seek advice. An important exception to this generalisation is the occurrence of oral squamous cell carcinoma, which is often painless in its early stages. Definitive diagnosis, which requires mucosal biopsy, is mandatory for any persistent area of oral ulceration.

Neutropenic ulcers in oncology: terminology, diagnosis, and management.

Neutropenic ulcerations are characterized by mucosal ulcerations which occur in the presence of neutropenia, suggesting a direct link between neutropenia and mucosal ulceration. An oral ulcer can be labeled as "neutropenic" only if the patients have primary (typically congenital) or secondary neutropenia, and neutropenia is the sole causative factor. Oral mucosal ulcers observed in patients undergoing oncologic therapy may also be termed as "neutropenic ulcers", but the pathogenesis of these oral ulcers more likely involves mucosal events related to trauma, microbial factors, and direct cytotoxicity. In cancer patients, the early appearance of oral ulcers is often attributed to oral mucositis which is a condition primarily caused by the direct mucosal cytotoxicity of chemotherapeutic agents and radiation therapy. Oral ulcers that develop later during or after active cancer therapy may result from intraoral trauma and typically manifest on non-keratinized areas of the oral mucosa which are more susceptible to mucosal damage. In patients undergoing chemotherapy, factors such as disturbances in mucosal barrier function as well as bone marrow suppression lead to reduced neutrophil count and function, and can contribute to the development of oral ulcers. While the etiology of oral ulcers in cancer therapy receiving patients can vary, it is important to emphasize that the host's response plays a crucial role in the progression and repair process of these lesions. This narrative review presents the etiopathogenesis, clinical presentation, and potential management approaches for oral ulcerations in neutropenic patients, with a particular focus on clarifying the usage of the term "neutropenic ulcer" since this term lacks diagnostic specificity and can be misleading in clinical practice regarding the underlying causes and treatment strategies.

How to recognise a Behçet's ulcer from other types of oral ulceration? Defining Behçet's ulceration by an International Delphi Consultation.

OBJECTIVES: To define the clinical characteristics of oral ulceration (OU) in Behçet's disease (BD), to allow differentiation from other causes of OU, including aphthous ulcers, by an International Delphi consultation. To develop a clinical guideline on how to recognise BD ulcers. METHODS: Round 1. 40 clinical images of OU in BD, recurrent aphthous stomatitis (RAS), inflammatory bowel disease (IBD) and mucous membrane pemphigoid (MMP) were shown. Participants answered, independently, which images would be consistent with a BD ulcer. Round 2. The results from marking independently were shown. The panel remarked the questions through iteration process. The images not agreed to be a possible BD ulcer were discarded. Round 3. 10 clinical descriptors that may define BD ulcers were suggested. Participants ranked the level of importance for each descriptor on each image presented. Round 4. Participants re-ranked their level of agreement for each descriptor through iteration process. Whether the clinical pictures would be different from RAS was also explored. A final agreement was reached. RESULTS: This study has shown clear differentiation between BD, IBD and MMP ulcers when defining them by phenotype through clinical images only. On the other hand, no differentiation between RAS and BD ulcers was found. The most important clinical descriptors that define BD ulcers have been agreed. CONCLUSIONS: New clinical guidance for Health Care Professionals (HCP) on how to recognise a BD ulcer has been proposed. This should elucidate an earlier diagnosis, quicker access to treatment and control of the disease enhancing patient's quality of life.

[Ulcerations of the oral mucosa]. / Ulceraties van het mondslijmvlies.

Ulceration is a common presenting sign of a wide spectrum of diseases of the oral cavity involving many etiologic factors, such as trauma, infection, neoplasms, medication, and immune related disorders, ranging from self-limited lesions to life-threatening diseases. In most cases, a proper diagnosis can be established based on medical history and clinical features only. Early diagnosis is important as oral ulcerations might be a manifestation of a systemic disease or sometimes even due to a malignant process.

Oral lesions in patients with human monkeypox: A systematic scoping review.

OBJECTIVES: To describe the clinical features and location of oral lesions in patients with human monkeypox. METHODS: A systematic scoping review was accomplished by implementing the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews. The analysis incorporated varied databases and the gray literature. Keywords were implemented to search publications in all languages until July 2022. RESULTS: The initial electronic exploration included 889 reports, of which 843 studies were eliminated. Reading the full text occasioned the omission of 27 additional investigations. Finally, 19 publications were included. These reports analyzed 1256 patients with monkeypox, mostly described in Europe. Most of them were men who have sex with men. The study population consisted mainly of adults but children were also infected. The oral lesions of monkeypox patients were observed in different parts of the oral mucosa, including lips and tongue, but mainly in the tonsils (15 cases). The oral lesions manifested as papules, vesicles, pustules, and ulcers. Erythema, edema, enanthema, and severe pain were also observed, accompanied by tonsillar enlargement. Sore throat was also reported. Monkeypox is accompanied by a significant number of systemic manifestations, mainly including multiple skin lesions throughout the body, as well as lymphadenopathy, fever, headache, myalgia, and fatigue, among others. The symptoms associated with monkeypox were managed with different antiretroviral and antimicrobial therapies and medications to control pain and fever principally. Seventeen deaths were informed. CONCLUSION: Most monkeypox-associated oral lesions are seen in different parts of the oral mucosa, mainly in the tonsils manifested as papules, vesicles, pustules, and ulcers.

Atypical presentation of Sweet syndrome with nodular erythema and oral ulcerations provoked by Ad26.COV2.S SARS-CoV-2 vaccination and review of literature.

The aim of this article is to present the case of acute febrile neutrophilic dermatosis (Sweet syndrome-SS) after Ad26.COV2.S vaccination against SARS-CoV-2. To the best of our knowledge, this is the second case of SS provoked by this specific vaccine. What is more, the mildly symptomatic beginning of the disease, later followed by typical SS manifestation with a variety of symptoms including nodular erythema of the feet and oral ulcerations, made it very challenging to establish the diagnosis. The article focuses on the current literature on the acute febrile neutrophilic dermatosis, along with the coexistence with other neutrophilic dermatoses and anti-SARS-CoV-2 vaccinations as provoking factors. It emphasizes the necessity for sharing the knowledge and experience on the subject of SS's clinical manifestations and underlying causes to facilitate prompt diagnosis and introduction of appropriate treatment.

Recognition and management of drug-associated oral ulceration: a review.

The number of people who are using prescribed medications is on the rise, largely due to an ageing population in the UK, but also because of early diagnosis and prompt medical management of a variety of conditions. Systemic medications may contribute to the development of oral side effects and translate into an increasing number of patients presenting in general dental practice settings. The aim of this paper is to provide an outline of oral side effects of systemic medications followed by a review of drug-associated oral ulcers (DAOUs). The paper also provides recommendations for early recognition and management of DAOUs in general dental practice settings, including referral to general medical practitioners and specialists in oral medicine.