Systemic lupus erythematosus presenting with oral mucosal lesions: easily missed?

Abstract

Two caucasian patients are described in whom oral mucosal lesions were the first manifestation of systemic lupus erythematosus. In both cases the diagnosis was delayed despite histological examination of oral lesions. Treatment with antimalarials and azathioprine was of significant benefit. In the absence of cutaneous or systemic features, distinguishing oral lupus erythematosus from lichen planus and epidermal dysplasia can be difficult, both clinically and on histology, and requires a high index of suspicion.

SYSTEMIC LUPUS ERYTHEMATOUS: SPECIFIC MUCOCUTANEOUS MANIFESTATIONS & SEROLOGICAL MARKERS AS KEY DIAGNOSTIC TOOLS: A SERIES OF 3 CASE REPORTS

“…7 A myriad of features appear in oral cavity, may be secondary to epithelial atrophy and subsequent scarring, including discoid lesions, cheilitis, white patches like lichen planus and erythematous buccal mucosa which were consistent with our cases reported here. 8 Our study also seems consistent with few studies depicting specific immunological changes as marked increase in anti-DS-DNA, ANA and IgE, which could be a key diagnostic tool in confirming the diagnosis of SLE. 9 Tissue damage is caused by platelets and neutrophils and the cascade is completed by involvement of complements C3a, C4a and C5a.…”

Oral Mucosal Lesions as Initial Presentation in Lupus Erythematosus Patient (A Case Report)

“…Distinguishing LE, PV, and EM is clinically difficult. Biopsy is required in addition for histopathological examination [22]. But in this case, the biopsy is not done because of patient's refusal.…”

“…According to the American College of Rheumatology's LE criteria in 1982 which was then revised in 2012 by Systemic Lupus International Collaborating Clinics (SLICC) oral mucosal lesions more than 54% of patients with LE with ulcers were the most commonly revealed lesions in which 44% were for sensitivity and 92% for specificity [6,18,19]. Oral manifestations were symptomatic in cases of LE where 40% for SLE and 24% for cases of DLE [22]. The most common areas for oral mucosal lesions are the palate, the buccal mucosa (22.3%); lips (12.2%) especially the lower lip in the form of erythema, erosive, and crusta [6,16,23].…”

“…Intra oral examination showed a shallow erosive lesion of the labial mucosa adjacent to the vermilion border ( Figure 2); the lesions on the buccal mucosa were bilateral whitish macula surrounded by erythema with diffuse borders ( Figure 3 and 4); sloughing and keratotic papules on the lateral tongue (Figures 5). In addition, she had bad oral hygiene, sub and supra gingival calculus was accompanied by inflammation of the gingival margin, and radix 18,17,16,14,12,22,23,36,35,34.…”

“…Oral mucosal lesion in LE patients has a wide spectrum of appearance, it results dentist may be confused to differ this lesion to other similar oral diseases, such as Oral Lichen Planus (OLP), Erythema Multiforme (EM). Consequently, it may lead to delayed diagnosis and management [7,22]. Early treatment could help LE patient increase their survival rates.…”