Case #24:

Case profile:

Patient: Adult male.

Case record:

Chief Complaint: Patient complains of a sore mouth of eight months duration. The discomfort has consistently involved the labial and buccal mucosa and the tongue. The sores fluctuate in size. The patient states that wearing partial dentures exacerbates the oral discomfort. Discontinuing colloidal gold medication exacerbated both the oral discomfort and arthritis.   Medical History: The patient was hospitalized ten months ago for pneumonia, which was successfully treated with antibiotics. Surgeries have included hernia repair, nasal polyp excision, removal of pilonidal cyst, appendectomy, and tonsillectomy. The patient reports rheumatoid arthritis of fifteen years duration, currently treated with Naprosyn. Lichen planus on the skin is treated with a steroid cream. Systemic steroids caused a skin rash, and aspirin causes bleeding problems. The patient reports asthma, alleries to pollen and some foods and medications.   Dental History: The patient has had partial dentures for eight years, and the current dentures are four years old. The patient hasn't worn the partial dentures for the past six months due to oral discomfort.   Clinical Findings: The buccal and lingual mucosa is erythematous with areas of epithelial thickening arranged in a lacy line pattern. Focal white plaques which rub off leaving a tender base are present on the mucolabial folds. All lesions are bilateral. Scaly white plaques on an erythematous base are present bilaterally on the palms, wrists, and elbows. Some of the white plaques have a lacy line pattern. The white epithelial thickening lesions on the skin and buccal and labial mucosa are thickened, firm, and rough to palpation. They do not rub off and are fixed to the surface mucosa. Ulcers on the lower lip are covered by firm crusts. Ulcers on the lower lip and buccal and lingual mucosa are tender to palpation.

Images:

Palm and Wrist LG Close-up of Lesions on Palm LG Lesions on the Elbow LG Lips LG Left Buccal Mucosa LG Left Buccal Mucosa LG Left Lateral and Ventral Tongue LG