Leukemia is a hematological malignant disease with various clinical symptoms. Due to the fatal nature of the disease, early detection is important. Oral manifestations include ulcers and gingival enlargement with bleeding. Moreover, myeloid sarcoma or opportunistic infections may also occur. This report introduces a 31-year-old male presenting with generalized gingival enlargement with bleeding and another 81-year-old female with neoplasm on the left retromolar area. Both were diagnosed as acute monocytic leukemia. These cases implicate that gingival enlargement or mucosal lesion in the oral cavity may represent underlying systemic diseases. Related to this, it has to be reminded that making timely diagnosis and referral according to the clinical findings is crucial.
Adult ; Aged, 80 and over ; Diagnosis ; Female ; Hemorrhage ; Humans ; Leukemia ; Leukemia, Monocytic, Acute ; Male ; Mouth ; Opportunistic Infections ; Oral Manifestations ; Referral and Consultation ; Sarcoma, Myeloid ; Ulcer

PURPOSE: Methimazole is an anti-thyroid drug that can cause life-threatening neutropenia in rare situations. The aim of this case report is to describe a set of oral complications associated with methimazole-induced neutropenia and the healing of the gingiva after proper treatment. METHODS: A 31-year-old female patient hospitalized for systemic symptoms of sore throat and fever and showing extensive gingival necrosis with pain was referred to the Department of Periodontics from the Department of Endocrinology. Methimazole-induced neutropenia was diagnosed based on blood test results and her medical history. Methimazole was discontinued and a range of treatments was administered, including the injection of granulocyte colony stimulating factor. RESULTS: After systemic treatment, the gingiva began to heal as the neutrophil count increased. Approximately one year later, the gingiva had returned to a normal appearance. Twenty-one months after treatment, sequestra of the alveolar bone that had broken through the gingiva were removed. Periodic supportive periodontal treatment has been continued uneventfully. CONCLUSIONS: The oral manifestations of gingival necrosis and ulcerations, in combination with systemic symptoms such as fever and sore throat, are the critical signs presented in the early stages of drug-induced neutropenia. Therefore, dentists need to be aware of these oral complications in order to make an accurate diagnosis and to ensure that prompt medical intervention is provided.
Adult ; Colony-Stimulating Factors ; Dentists ; Diagnosis ; Endocrinology ; Female ; Fever ; Follow-Up Studies* ; Gingiva ; Granulocytes ; Hematologic Tests ; Humans ; Hyperthyroidism ; Methimazole ; Necrosis* ; Neutropenia* ; Neutrophils ; Oral Manifestations ; Periodontics ; Pharyngitis ; Ulcer

PURPOSE: To Report A Case Of Atypical Acute Retinal Necrosis (Arn) Observed Using Ultra-wide-field Imaging. CASE SUMMARY: A 50-year-old male with recurrent oral ulcer presented with visual loss in his right eye. On the initial visit, slit-lamp examination showed inflammatory cells (3+) in the anterior chamber and vitreous of the right eye. Funduscopic examination and ultra-wide-field fundus images showed severe occlusive vasculitis with perivascular hemorrhage. No necrotic lesion was observed at the peripheral retina in the left eye. Under the impression of Behcet's uveitis, immunosuppressive therapies including oral steroid, intravenous cyclophosphamide, anti-tumor necrosis factor (TNF) alpha agent and intravitreal triamcinolone were administered, but without improvement. Subsequently, a necrotic lesion appeared at the far peripheral retina in the right eye and varicella-zoster virus was identified using the polymerase chain reaction test. After the patient was diagnosed with atypical ARN, intravenous acyclovir was administered, resulting in eventual suppression of the necrotic lesion progression. Due to retinal detachment, pars plana vitrectomy with silicone oil infusion was performed in the right eye. At that time, a whitish lesion at the far peripheral retina in the ultra-wide-field photography of the fellow eye was found and 3 intravitreal ganciclovir injections were administered. Finally, the whitish lesion regressed after 1 month. CONCLUSIONS: Ultra-wide-field imaging might be useful for diagnosis and follow-up of atypical ARN patients.
Acyclovir ; Anterior Chamber ; Cyclophosphamide ; Diagnosis ; Ganciclovir ; Hemorrhage ; Herpesvirus 3, Human ; Humans ; Male ; Middle Aged ; Necrosis ; Oral Ulcer ; Photography ; Polymerase Chain Reaction ; Retina ; Retinal Detachment ; Retinal Necrosis Syndrome, Acute* ; Silicone Oils ; Triamcinolone ; Uveitis ; Vasculitis ; Vitrectomy

Adult ; Coinfection ; HIV Infections ; complications ; Humans ; Male ; Oral Ulcer ; complications ; diagnosis ; Syphilis ; complications ; diagnosis ; Tongue Diseases ; complications ; diagnosis

We report a case of atypical pityriasis rosea in a 24-year-old Malay man. He presented with an 11-month history of three recurrent and persistent episodes of pityriasis rosea associated with oral ulcers. The first episode lasted for one month and recurred within 14 days. The second episode lasted for three months and recurred within nine days. The third episode lasted for seven months. Although all three episodes were not preceded by any prodromal symptoms, a herald patch was noted on three different sites (the left iliac fossa, abdomen and chest) on each successive episode. Recurrent pityriasis rosea and its association with oral ulcers, although quite uncommon, have been reported in the literature. However, reports of multiple recurrences, with prolonged duration of each episode and very short remissions in between, have not been made. To the best of our knowledge, this is the first report of such unique presentation.
Adult ; Diagnosis, Differential ; Exanthema ; diagnosis ; pathology ; Humans ; Male ; Oral Ulcer ; complications ; diagnosis ; Pityriasis Rosea ; diagnosis ; pathology ; Recurrence ; Treatment Outcome

The pathogenesis of acquired immune deficiency syndrome-associated recurrent oral ulcerations (AIDS-ROU) remained obscure and these was no specific treatment for it. Syndrome differentiation in traditional Chinese medicine (TCM) focus on integral regulation and has an advantage of the disease that etiology and pathogenesis remain obscure. A draft of Chinese medicine diagnosis and treatment standard procedure for AIDS-ROU was established by literature retrieval and peer review. Two questionnaires were carried out to investigate the confirmation and advice of in-group specialist to key points of the draft including diagnosis, treatment and nursing. Then the procedures were revised accordingly. The preliminary results showed the recovery rate of complete questionnaires in the 1st survey was 96%. Specialists confirmed more on outline, case history and physical examinations, syndrome differentiation of hyperactivity of fire due to Yin deficiency syndrome (HFYDS), treatment of heat accumulated in heart and spleen syndrome (HAHSS) and HFYDS, treatment of western medicine and nursing. They held different opinions on incidence, treatment of deficiency of spleen-QI and stomach-QI syndrome (DSSS) and criterion of therapeutical evaluation. Cronbach coefficient alpha (CCA) was 0.998 and split-half reliability R was 0.91. Recovery rate of complete questionnaires in 2nd survey was 100%. Specialists confirmed more on outline, etiology and pathogenesis, case history and physical examination, auxiliary examination, diagnostic criteria, syndrome differentiation and treatment of HAHSS and HFYDS. They held different opinions on syndrome differentiation and treatment of intermingled cold and heat syndrome and DSSS, nursing and the other therapies. CCA was 0.428 and split-half reliability R was 0.96. Coefficient of variations of the 2nd survey were less than those of the 1st survey, which mean coordination was improved. Each single item in two surveys contributed less difference in overall results according to weight coefficients. A new revision of the procedure was preliminarily established according to results of two surveys. Experts'activeness, concentration and coordination were good in two surveys. They had reached consensus in key points of the draft including diagnosis, treatment and nursing on the whole.
Acquired Immunodeficiency Syndrome ; complications ; Consensus ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; standards ; Oral Ulcer ; complications ; diagnosis ; therapy ; Recurrence ; Reference Standards ; Surveys and Questionnaires

Antigens, CD20 ; metabolism ; Diagnosis, Differential ; Humans ; Infectious Mononucleosis ; metabolism ; pathology ; Leukocyte Common Antigens ; metabolism ; Lymphoma, Extranodal NK-T-Cell ; diagnosis ; metabolism ; pathology ; Nose Neoplasms ; diagnosis ; metabolism ; pathology ; Oral Ulcer ; metabolism ; pathology ; RNA, Viral ; metabolism ; Rhinoscleroma ; metabolism ; pathology

Crohn's disease is a chronic inflammatory bowel disease that can involve the whole gastrointestinal tract. The orofacial manifestation of Crohn's disease, which is rare, can develop irrespective of intestinal involvement. These orofacial lesions are often misdiagnosed as simple oral ulcers. Corticosteroids are the mainstay of therapy for orofacial Crohn's disease. However, infliximab, the chimeric monoclonal antibody to tumor necrosis factor-alpha, is now considered as a primary treatment because of the disease's relatively high rate of steroid resistance. We present a case of deep oral ulcer and periorbital swelling in a 65-year-old woman. She was diagnosed with intestinal Crohn's disease 7 years ago, which was in remission after treatment with an immunosuppressive agent (azathioprine). The patient was given the diagnosed with orofacial Crohn's disease and successfully treated with infliximab.
6-Mercaptopurine/analogs & derivatives/therapeutic use ; Aged ; Anti-Inflammatory Agents/*therapeutic use ; Antibodies, Monoclonal/*therapeutic use ; Crohn Disease/diagnosis/*drug therapy ; Female ; Gastrointestinal Diseases/pathology ; Humans ; Immunosuppressive Agents/therapeutic use ; Oral Ulcer/diagnosis

We report here a case of vascular Behcet's disease. 32-year-old young woman who suffered from chest pain was diagnosed with acute myocardial infarction four years before admission. At that time she manifested symtoms of Behcet's disease, such as oral ulcers, genital ulcers, multiple arthralgia, and a peculiar hyperirritability reaction to needle puncture. At this time she was admitted due to acute chest pain and intermittent abdominal pain. The diagnosis of an acute anteroseptal myocardial infarction was made on the basis of the electrocardiography findings. Cardiac catheterization revealed segmental stenosis up to 95% at the mid-left anterior descending artery without aneurysm formation at other coronary trees and there were no atherosclerotic changes. Coronary stent was inserted in the lesion. Abdominal CT showed inferior vena cava and right hepatic vein obstruction, which supports the diagnosis of Budd-Chiari syndrome. Our case demonstrated the followings which are not common to vasculo-Behcet disease; 1) initial clinicopathologic manifestations at the coronary artery, 2) abrupt total occlusion with clear cut lesion at left anterior descending artery, 3) recurrent myocardial infarctions, 4) Budd-Chiari syndrome, 5) combined superior mesenteric artery, inferior mesenteric artery and celiac trunk obstruction. Among the systemic manifestation of Behect's disease, cardiac involvement is very rare but should be considered as one of the most important features that influences the prognosis.
Abdominal Pain ; Adult ; Aneurysm ; Anterior Wall Myocardial Infarction ; Arteries ; Arthralgia ; Budd-Chiari Syndrome* ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Constriction, Pathologic ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Female ; Heart Diseases ; Hepatic Veins ; Humans ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Myocardial Infarction* ; Needles ; Oral Ulcer ; Prognosis ; Punctures ; Stents ; Tomography, X-Ray Computed ; Ulcer ; Vena Cava, Inferior

BACKGROUND: Lead is a common environmental metal and has been used for various purposes for a long time, leading to frequent reports of lead poisoning. The concern about lead poisoning starts has been mostly focused on occupational exposure and is linked to the prevention and management of lead exposure in refining and manufacturing processes. Nowadays, however, there is growing concern about nonoccupational lead exposure by many pollutants. Especially, lead poisoning by herb medicine has commonly been observed in clinics in Southeast Asia and South Korea. This case report contains diagnosis of inpatients who suffered from lead poisoning from a herb medicine, arthritis remedy and who complained of abdominal symptoms and dizziness. The study purpose was to awaken our healthful interest in lead poisoning. CASE REPORT: A 53-year-old female patient complaining of abdominal pain, dizziness, and numbness of hand and foot came to our hospital due to the continuation of her anemic finding symptoms while undergoing treatment at a secondary hospital. Her past medical history was unremarkable except she had taken herb pills for about a year which were administered by herb medicine to treat arthritis. Physical examination was unremarkable except for oral ulcer finding. Hemoglobin was 8.5 g/dl, reticulocyte count was 4.10%, bilirubin was 1.3 mg/dl (direct 0.3 mg/dl), and Zinc protoporphyrin 169.12 ug/dl. In urinalysis results, WBC increased to 30~39 /HPF, While AST/ALT, BUN/Cr, PT/aPTT, and nerve conduction velocity were normal. Basophilic stippling was observed through peripheral blood smear. The blood lead level was 80.4 microgram/dl and the urine lead level continued to increase to 541 microgram/l. Analysis of the pills that the patient had been taking showed that they contained 30 mg/g lead. By oral chelation therapy with D-penicillamine four times per day for five days, the patient's hemoglobin increased to 11.8 g/dl, while blood lead level decreased to 39.2 microgram/dl, and urine level to 196 microgram/l. Although the soles of her feet remained cold, but other symptoms and anemia finding were improved considerably. However, after discontinuing D-penicillamine medication, the blood lead level increased to 41.4 microgram/dl again. The further administration of D-penicillamine for five days reduced the blood lead level to 31.5 microgram/dl. At two years after the discontinuance of D-penicillamine, the followup findings were normal; hemoglobin was 13.1 g/dl, hematocrit 39.6%, reticulocyte count 1.22%, blood lead level 13.3 microgram/dl, and urine lead level 9.17 microgram/l. CONCLUSION: After taking herb medicine pills for one year, the patient was admitted to hospital chiefly complaining of abdominal pain, dizziness, and numbness of the hand and foot. The high blood and urine and lead levels and lead chemical analysis of the herb pills confirmed lead poisoning which was treated with D-penicillamine for five days. The follow-up result after two years indicated normal blood and urine lead levels.
Abdominal Pain ; Anemia ; Arthritis ; Asia, Southeastern ; Basophils ; Bilirubin ; Chelation Therapy ; Diagnosis ; Dizziness ; Eating* ; Female ; Follow-Up Studies ; Foot ; Hand ; Hematocrit ; Humans ; Hypesthesia ; Inpatients ; Korea ; Lead Poisoning* ; Middle Aged ; Neural Conduction ; Occupational Exposure ; Oral Ulcer ; Penicillamine ; Physical Examination ; Reticulocyte Count ; Urinalysis ; Zinc