ORAL MUCOSAL LESIONS IN A COVID-19 PATIENT: A CASE REPORT

Because the oral health of patients with COVID-19 can be affected by the infection, there is doubt whether these manifestations could be a typical pattern resulting from the direct viral infection or result from systemic deterioration. A 24-year-old woman was referred to the general clinical doctor complaining about fever, headache, and shortness of breath lasting around 5 days. Medical history was unremarkable. A nasopharyngeal swab (reverse transcriptase polymerase chain reaction) for SARS-CoV-2 was positive. Azithromycin and supportive treatment were prescribed. On the fifth day after the onset of symptoms (2 days after the start of antibiotic) the patient complained about sores in the mouth. Intraoral examination showed several painful, red ulcers with irregular margins and varying sizes and a nonhemorrhagic background in the oropharyngeal region. Topical anesthetic mouthrinse was prescribed. Two weeks after the initial signs, the patient is symptom free with no evidence of local or systemic disease.

CLINICAL AND HISTOPATHOLOGIC FEATURES OF COVID-19 IN ORAL MUCOSA: A SYSTEMATIC REVIEW

Objectives

To investigate the demographic, clinical, and histologic features of patients with COVID-19 who present oral lesions.

Study design

An electronic search was conducted by 2 reviewers in 6 databases. Absolute and relative frequencies were obtained by descriptive analysis.

Results

Three publications comprising 4 cases were included. Mean patient age was 54.75 (±14.7) years, and males (n = 3, 75.0%) were more often affected. All patients (100%) were White. All individuals presented comorbidities, with the most common being diabetes (n = 2, 28.6%), hypertension (n = 2, 28.6%), and coronary heart disease (n = 2, 28.6%). All lesions presented as symptomatic ulcers (n = 4, 100%). The mean evolution time was 5 days. Hard palate (n = 2, 28.6%), tongue (n = 2, 28.6%), buccal mucosa (n = 2, 28.6%), and lip (n = 1, 14.2) were the affected sites. Regarding histologic features, the most frequent were the following: koilocytes (n = 4, 100.0%), ulcer (n = 3, 75.0%), exocytosis (n = 3, 75.0%), acute inflammation (n = 3, 75.0%), chronic inflammation (n = 2, 50.0%), and thrombus (n = 1, 25.0%). Of informed immunohistochemical markers, HSV 1 /2, CD20, CD68, CD163, CD163, CD4, CD34, CD3, and CD8 showed positivity. The mean follow up was 11.7 days with total remission of 3 (75.0%) lesions.

Conclusions

There is still doubt as to whether intraoral manifestations of COVID-19 patients could be a typical pattern resulting from direct viral infection or from systemic deterioration. Further investigation is needed.

Morphological and tissue-based molecular characterization of oral lesions in patients with COVID-19: A living systematic review

OBJECTIVE

This living systematic review aims to integrate the morphological and tissue-based molecular characterization of oral lesions occurring in individuals infected by COVID-19 (OLICs).

MATERIALS AND DESIGN

This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Web of Science, Scopus, Ovid, Embase, and LILACS were searched to identify reports on OLICs with morphological and/or tissue-based molecular data.

RESULTS

Four studies reporting five cases were included. Three patients were male, and the mean age of the individuals was 47.6 years. The most reported anatomical location was the palate (n = 4), whereas ulcers were the most frequent clinical presentation (n = 3). Histopathologically, all cases revealed cell vacuolization and exocytosis in the epithelial layer. In the mesenchymal layer, inflammatory cell infiltrate and thrombi/microvascular thrombosis were observed in three cases. Immunohistochemical reactions were performed in two cases. Both cases were negative for HHV-1, HHV-2, and CMV. One case revealed positivity for SARS-CoV-2 spike protein. No other molecular tests were found for the characterization of OLIC.

CONCLUSIONS

The pathological characteristics of OLICs are still unspecific. However, with the ongoing COVID-19 pandemic and well-documented new cases, whether OLICs are due to coinfections or has a primary origin can be determined.

Oral pigmented lesions in syndromic individuals: A systematic review

OBJECTIVE

To systematically integrate the available data published in the literature on oral pigmented lesions (OPL) associated with syndromes, summarizing the clinical and demographic features of the individuals.

MATERIALS AND METHODS

An electronic search was undertaken in six databases. Eligibility criteria were articles in English, Spanish, and Portuguese describing case reports or case series of OPL associated with syndromes. Data were aggregated and statistically evaluated.

RESULTS

About 108 articles reporting 149 cases of individuals with syndromes were identified. Among the affected individuals, nine syndromes were reported. The mean age at diagnosis was 35.93 years (0.41 to 83 years), with a predilection for white (n = 85/85.86%) female (n = 102/68.46%) individuals. As regards the number of lesions, 109 (73.15%) were multiple and 40 (26.85%) were single. Lip represented the anatomical location more affected (122 cases/38.01%), followed by the buccal mucosa (100 cases/31.15%). Brownish lesions accounted for 82 (69.49%) cases. The mean time of evolution was 10.52 years (0.16 to 56 years). OPL preceding diagnosis of the syndrome was observed in 111 (74.50%) cases.

CONCLUSIONS

Although these syndromes are uncommon, dentists should be able to recognize their manifestations, since oral manifestations can represent an important aspect in early diagnosis.