BC oral pathology case No. 43: The pathology with multiple manifestations

Sept. 20, 2019

In Dr. Stacey Gividen’s oral pathology case, a patient presents with painful/burning lesions in her mouth and numerous “bumps” on her body and arms. She wonders if there could be any relationship between the two.

Stacey L. Gividen, DDS

Case presentation

A 75-YEAR-OLD FEMALE PRESENTS to the office for a recare exam with a chief complaint of painful/burning lesions in her mouth, with a duration of two weeks. She additionally reported that her body and arms had numerous “bumps” that manifested over the course of the last six weeks, and she was wondering if there was any relationship between the two.

Patient history

The patient had been seen recently by her primary care physician (PCP) for the lesions on her body and arms as well as for other symptoms that included fatigue, joint pain, and tenderness. Her PCP ordered blood tests to be taken over a six-week interval and then another office visit to discuss a definitive diagnosis.

In the interim, the patient was placed on methotrexate. She mentioned that her mouth had seemed drier over the last few weeks, but she didn’t think much of it until the oral lesions appeared about two weeks ago. She elaborated and said that initially, the gums/tissues in her mouth were all red and then eventually changed over to painful white patches.

Clinical exam

Clinical assessment revealed generalized ulcerated lesions intraorally, primarily focused on the buccal mucosa (figures 1 and 2). Furthermore, the tongue was coated with a white plaque-like layer.

Presentation of the lesions on the patient’s arms showed numerous purplish flat-topped bumps, which had been scarred over somewhat as a result of her scratching them regularly. Overall, however, the lesions looked like they were on the mend (figures 3–5).

Figure 3: Arm lesions, appearing to be in the healing stage

Figure 4: Arm lesions, appearing to be in the healing stage

Figure 5: Arm lesions, appearing to be in the healing stage

What is your assessment of the lesions and their relationship (if any) and potential differentials?

Send your responses to [email protected]. Next month, we will present the final diagnosis and recommended treatment for this oral pathology case.

CALL FOR PATHOLOGY CASES

Do you have an interesting oral pathology case you would like to share with Breakthrough’s readers? If so, submit a clinical radiograph or high-resolution photograph, a patient history, diagnosis, and treatment rendered to [email protected].

Editor's note: This article originally appeared in Breakthrough Clinical, a clinical specialties newsletter from Dental Economics and DentistryIQ.

Stacey L. Gividen, DDS, a graduate of Marquette University School of Dentistry, is in private practice in Hamilton, Montana. She is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. Dr. Gividen is the editorial director of Endeavor Business Media’s clinical dental specialties e-newsletter, Breakthrough Clinical,and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. She also serves on the Dental Economics editorial advisory board. You may contact her at [email protected].

About the Author

Stacey L. Gividen, DDS

Stacey L. Gividen, DDS, a graduate of Marquette University School of Dentistry, is in private practice in Montana. She is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. Dr. Gividen has contributed to DentistryIQ, Perio-Implant Advisory, and Dental Economics. You may contact her at [email protected].