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.