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A clinical and radiologic study of early and late manifestations in tuberculoid, dimorphous, and lepromatous leprosy was undertaken in order to determine characteristics, occurrence, and incidence of facial and oral lesions. Dermal, mucosal, neural, skeletal, and dental changes were correlated with the duration of leprosy, duration of treatment, and age of the patient.
Plasmablastic lymphoma is a relatively new entity that is considered to be a diffuse large B-cell lymphoma with an unique immunophenotype and a predilection for the oral cavity. We present a 50 year-old HIV-positive, bisexual, white male with a CD4 count 300/mm(3) and a viral HIV-RNA polymerase chain reaction (PCR) load of 237 copies/ml, who developed a painful, purple-red mass in the edentulous area of the maxillary right first molar. Erythematous gingival enlargements of the interdental papillae were seen in three of the dental quadrants. In addition, the patient was being managed with antiretroviral therapy and liposomal doxorubicin for recurrent cutaneous Kaposi's sarcoma (KS). Although oral KS was suspected, the gingival lesions were biopsied because they were refractory to chemotherapy and a lymphoma could not be excluded. Histopathologic examination revealed a lymphoid malignant neoplasm, consistent with a plasmablastic lymphoma. Immunoreactivity with vs38c, CD79a, kappa light chain, and IgG was readily identified in tumor cells; while only focal cells expressed CD20 and LCA (CD45RB). CD56, CD3, lambda light chain, and EMA were non-reactive. EBV was detected in the tumor by Southern hybridization, PCR amplification, in situ hybridization for EBER-1 DNA, and immunohistochemistry for latent membrane protein-1. The same tumor was negative for HHV-8 by PCR. Recognition of plasmablastic lymphoma is important, because it represents an HIV-associated malignancy that predominantly involves the oral cavity, may mimic KS and has a poor prognosis.
A patient seeking dental care was diagnosed with acute myelomonocytic leukemia and referred to a hematologic-oncologic service for confirmation and treatment. The typical oral findings and a discussion of the disease process of acute leukemia are presented.
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We report the case of a 46-year-old male patient with advanced HIV infection who developed an oral ulcer caused by Mycobacterium kansasii. It is the first description of an aphthous-like ulcer caused by this nontuberculous mycobacterium. As the AIDS epidemy is still growing, more cases might be observed and the current spectrum of differential diagnosis should be expanded.
Cowden's disease, or multiple hamartoma syndrome, is an autosomal dominant genodermatosis, characterized by the presence of multiple cutaneous hamartomas, oral fibromas and benign acral keratosis. It affects multiple organs (breast, thyroids, stomach, colon), with the strong possibility of malignant neoplasia developing in these organs. We present a case of this rare syndrome, highlighting the presentation of some clinical characteristics that, in suspected cases, can help to establish an early diagnosis of this disease, this being of great importance given the high frequency of tumors in people with this clinical picture.
We present two cases of keratosis lichenoides striata. Both patients have the typical features of the disease: linear verrucous formations on the limbs, and a seborrheic--like dermatitis. The oral mucosa was involved, showing erythematous patches and papules. A treatment by etretinate did not bring a significant improvement.
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The use of antineoplastic agents is rapidly increasing. A general classification of these drugs and their mechanisms of action is presented. Many of the drugs have an adverse effect on oral tissue, and the practicing dentist today must be well acquainted with these effects. A discussion of the features of these reactions and their management is presented.
BACKGROUND: Measles is a highly contagious, viral infectious disease affecting mainly children and young adults. It is characterized by high fever, maculopapular rash, keratoconjunctivitis and pathognomonic oral Koplik's spots. METHODS: During an outbreak of measles among soldiers in the Israeli military, patients were referred to one medical center where they were also examined for oral signs and symptoms of their illness. RESULTS: We present a case of measles infection with distinct oral findings. These included Koplik's spots, various forms of ulcerations of the free mucosa, -like gingivitis and pericoronitis. All oral lesions resolved after cessation of systemic illness. CONCLUSIONS: The measles virus is associated with a transient inhibition of the host response. Immunosuppression may create the necessary condition for the proliferation of pathobacteria associated with the observed pericoronitis and the other gingival lesions.
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Ultraviolet irradiation inhibits the proliferative responses of lymphoid cells to mitogens and alloantigens by inactivation of T lymphocytes and antigen-presenting cells. Its immunosuppressive capacity led to the introduction of UV irradiation into clinical practice for the treatment of dermatologic manifestations of chronic graft-versus-host disease. The cumulative experience with psoralen-UV-A rays in the treatment of cutaneous and oral graft-versus-host disease was the incentive for the application of oral UV-B rays in 2 patients with oral graft-versus-host disease signs and symptoms after allogeneic marrow transplantation. Intraoral UV-B irradiation (0.02 mJ/cm(2)) was administered 2 or 3 times per week on an ambulatory basis; the dose was increased by 0. 02 mJ/cm(2) every fourth session. Both patients responded early and satisfactorily, displaying only minimal side effects at a relatively low cumulative dose. Intraoral UV-B proved a valuable modality in the treatment of resistant chronic oral graft-versus-host disease.
Paracoccidioidomycosis (South American blastomycosis) is an uncommon, progressive systemic mycosis, potentially fatal if untreated. It is virtually restricted to persons spending time in Latin America. Reports of oral lesions are extremely rare in the English-language literature. Three adults with oral lesions as the first sign of paracoccidioidomycosis are described; this appears to be the largest series in the dental literature. The oral lesions had a characteristic appearance with a granular purpuric surface. The upper gingiva was a typical site, but lesions were also seen in the palate, tongue, and buccal mucosa. Two of the patients proved to have detectable pulmonary involvement. Long-term systemic ketoconazole therapy produced resolution of oral lesions in all cases.
BACKGROUND: Sensitization to gold in a large group of patients suspected of clinical allergy to this metal has not been reported. OBJECTIVE: Two hundred patients with symptoms of persistent oral mucosal or cutaneous lesions that were possibly related to allergy to constituents of gold alloys or gold jewelry were patch tested to determine the frequency of sensitization. METHODS: Patch testing was performed with the European standard series and a series of dental materials including three different salts of gold. A persistent papular reaction to gold-(tri)chloride was considered a positive reaction. RESULTS: In 17 patients (8.5%, all women, mean age 50.2 years) persistent papular patch test reactions to both 0.5% and 1.0% gold(tri)chloride were observed. In five of seven patients with oral lichen planus (OLP) and in one of six patients with the burning mouth syndrome, gold in the dentures was replaced. Particularly in patients with OLP, a significant but variable improvement was observed. In all cases in which gold was replaced and improvement occurred, the patients were sensitized to 0.5% gold(tri)chloride. One patient with allergic contact stomatitis and one patient with allergic contact dermatitis healed completely after gold had been replaced. CONCLUSION: Sensitization to gold should be considered as a possible cause of allergic contact dermatitis and allergic contact stomatitis as well as a pathogenic or triggering factor in OLP.
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