Case report
A 70-year-old female patient consulted the oral medicine and oral surgery department of the academic dental clinic of Monastir, Monastir, Tunisia, with a chief complaint of 5 months on defusing oral lesions causing pain, burning mouth sensation, and discomfort, especially with chewing and speaking.
The medical history was significant to hypothyroidism, high blood pressure, Cardiac arrhythmia, and type II diabetes mellitus. Her medication included Levothyrox® 125µg per day, Actopril®, and insulin injections.
Extraoral examination showed itchy purplish patches over the arms and legs, and diffuse crusty ulcerative lesions over her lower lip (Figure 1A). These lesions were painful, bleeding with a tendency to infiltrate the adjacent skin.
The intraoral examination revealed poor oral hygiene, a deteriorated metallo-resinous bridge extending from the right mandibular canine to the second left premolar, and multiple amalgam fillings.
Diffuse erosive areas extending from the premolars region up to the retromolar area of the buccal mucosa were detected (Figures 1B and 1C). These erosions were surrounded by white radiating striae from the periphery of the lesions symmetrically on both sides. Similar lesions with an erythematous background were noted over the upper and lower, anterior and posterior vestibular regions, dorsal and ventral surfaces of the tongue, and the interior surface of the lower lip (Figures 1D and 1E), and posterior maxillary edentulous ridge (Figure 1F). Gingiva showed marginal erythema with superficial erosion on the attached gingiva. The lesions were extremely painful and sensitive to touch.