Orolabial Lymphogranuloma Venereum, Michigan, USA

Orolabial lymphogranuloma venereum was diagnosed for a man in Michigan, USA, who had sex with men, some infected with HIV. High index of suspicion for lymphogranuloma venereum led to accurate diagnosis, successful therapy, and description of an L2b variant with a unique genetic mutation.

An extraordinary case of syphilis presenting with a labial ulcer

In the differential diagnosis of patients with ulcers on the lips characteristics like the duration of the ulcer, number, size, depth, shape, base, margins, and distribution are considered. Such ulcers arise from many diseases particularly, viral and bacterial infections, malignancies can also be responsible. Classic syphilitic chancres are painless erosions settled on hard papule; these are evident in the genital area in more than 90% of patients. This study describes a case of a 38-year-old female patient presenting with a painful ulcer covering 3 quarters of the upper lip showing settlement on erythematous, edematous, and indurated plaque covered with hemorrhagic crusts. The aim of this study was to consider differences between the classic syphilitic chancre typically found in the genital region from extragenital chancres and to raise awareness of the possibility of primary syphilis when patients present with painful ulcers on the lip.

Syphilitic Chancre of the Lips Transmitted by Kissing: A Case Report and Review of the Literature

Primary syphilic chancre most often involved genitalia, with 12% to 14% extragenital lesions. This article describes a rare case of a female patient with labial ulcer and diagnosed as oral syphilis (OS), an uncommon presentation of primary syphilis. OS is transmitted through orogenital contact.This study is case report and literature review.We report a 27-year-old woman with painless, ulcerative, and indurated lesion on her lower lip and a 7-day history of symmetrically distributed nonpruritic macules. OS was diagnosed based on clinical presentations and serologic test and patient's oral ulcer was cured with intramuscular penicillin G benzathine. However, both the patient and her husband denied any orogenital sexual history before. In addition, her husband was also diagnosed as syphilis later in our clinic. He reported having orogenital contact with other people.Therefore, this is a rare case of OS transmitted through kissing.

An Unusual Extranodal Presentation of Mycobacterium Tuberculosis in the Upper Lip

Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide, with a peak incidence in South-East Asia and Sub- Saharan Africa. A significant number of patients in the UK are affected. Extra-pulmonary TB presentation varies, and includes head and neck manifestations that can present on routine examination in the dental practice setting. We report an unusual case of extra-nodal TB in the upper lip, and provide some guidance to general dental practitioners on the presenting features of such lesions, and what to refer for further investigation where TB is included in the differential diagnosis. CPD/CLINICAL RELEVANCE: This case report highlights important factors in TB diagnosis, with particular emphasis on presenting features relevant to general dental practitioners, and informs on the accepted and current treatment regimen.

Disseminated tuberculosis with involvement of prostate--a case report

We present a 55-year-old male who presented with painful non-healing ulcers on the lower lip and scrotum associated with productive cough, fever, anorexia and dysuria. Erythrocyte sedimentation rate was raised, sputum was positive for acid fast bacilli. Chest X-ray was suggestive of pulmonary tuberculosis. A prostate biopsy was also suggestive of tuberculosis. A diagnosis of disseminated tuberculosis was made and the patient showed a good response in two weeks.

Perioral abscess associated with isotretinoin

Severe scarring acne is frequently treated with isotretinoin. Patients treated with this drug may expect some of the more common complications including mucositis. Less common complications may also occur in a small number of patients. While undergoing treatment, patients may become colonized with Staphylococcus bacteria. However, the incidence of perioral abscess formation in patients taking isotretinoin is not commonly reported and the onset of this adverse event may masquerade as angioedema or severe mucositis.This article presents a case of a significant perioral abscess and discuss the need for prompt recognition as well as treatment of the infection.The case reported is unique due to the extent and severity of the abscess.

[Conidiobolomycosis, a rare fungal tumor: a case report in Ouagadougou, Burkina Faso]

Conidiobolomycosis is a deep, rare mycosis, due to Conidiobolus coronatus which is a saprophyte of vegetation in decomposition. We report one case in Burkina Faso. A 17 years old man, shepherd, consulted for tumefactions on the face. It could date back insidiously to a traumatism, one year before. A month later some painless tumefactions appeared on the cheekbone, the right eyelid, the nose with epistaxis. The upper lip then the lower one had swollen. Dermatological exam revealed multiple, painless, hard, sub-cutaneous swellings, affecting the cheekbone, the eyelids, the root and the ala of the nose. This tumefaction sometimes adhered to underlying tissues and to the overlying skin, sometimes mobile; painless and hard swelling of the two lips was also noted. ENT exam showed an inflammation of the nasal mucous without ulceration and the permeability of the nasal tracts was subnormal. The cephalic tomodensitometry showed a thickness of the soft tissues of the lips and the nose with an infectious feature associated to a pansinusitis without bone lesion. Histology was in favour of conidiobolomycosis. The patient was treated with fluconazole and the swelling progressively disappeared. Conidiobolomycosis is a disease generally reported in some humid tropical countries. It begins in the nasal cavities leading then to a nasal obstruction. This case was singular by the fact it happened in a dry Sudano-Sahelian climate and by its clinical features.

Microbial-associated oral lichenoid reactions

OBJECTIVE

The objective of the present study was to compare a new type of symptomatic lichenoid reaction, specifically located on the mucosal side of the lips, and associated with microorganisms, with a matched group presenting with reticular oral lichen planus (OLP) of the buccal mucosa.

PATIENTS AND METHODS

The mean age for both groups was 66 years with a predominance of women (62%). The lichenoid reaction group (n = 25) presented with a reticular reaction pattern embracing various degrees of erythema. Patients presenting with OLP had similar lesions confined to the buccal mucosa but not on the mucosal side of the lips.

RESULTS

In both groups, 80% were on any type of medication. However, 56% of the patients with lichenoid reactions medicated with more than three drugs compared with 29% (P < 0.05) in the OLP group. The former group more often used medicaments prescribed for cardiovascular diseases (48%vs 25%). Twenty-two of the patients with lichenoid reactions were treated with chlorhexidine. In 80% of these patients (n = 18), the lesions improved or completely healed, indicating a microbial association.

CONCLUSION

Lichenoid reactions present on the mucosal side of the lips may be initiated by microbial plaque precipitated on the buccal surfaces of the anterior teeth.

[Diagnostic image (185). A man with a pimple on the upper lip. Carbuncle of the upper lip]

A 24-year-old man presented with a carbuncle of the upper lip. Surgical drainage was installed and flucloxacillin was administered. Full recovery ensued. In culture Staphylococcus aureus was abundant.

Chronic disseminated histoplasmosis in an apparently immuno-competent Belgian patient

A 77 year-old Belgian man was admitted for weight loss and elevated liver enzymes. He used to live in Central Africa until 1986 and denied any travel outside Belgium during the last decade. Physical examination was unremarkable except for a lip ulceration. Blood tests showed increases of liver enzymes and CEA. In the search of an abdominal cancer, CT showed a normal liver but enlarged surrenal glands, while colonoscopy disclosed multiple mucosal lesions. Colic and lip biopsies identified Histoplasma capsulatum var capsulatum. HIV serology was negative. Lymphocyte count was normal but lymphocyte function was depressed. The patient dramatically improved under oral treatment with Itraconazole 400 mg daily for six months. This case indicates that chronic disseminated Histoplasmosis can reactivate in a healthy and apparently non-immunocompromised person living in Europe.

New split scar cheek flap in reconstruction of noma sequelae

The use of a split-scar cheek flap is demonstrated for restoration of lining in reconstructing the oral commissure in cases of noma.

Acute streptococcal infection of the gingiva, lower lip, and pharynx--a case report

BACKGROUND

Streptococcal gingivostomatitis is a rare phenomenon in a non-compromised host and not commonly reported in the dental literature. Early diagnosis and distinction from viral infections, especially HSV infection, are of the utmost importance. The early use of penicillin is essential in preventing a cascade of events, resulting in severe fasciitis, destruction of tissues, and subsequent rheumatic fever and rheumatic heart disease.

METHODS

A unique case of group A beta-hemolytic streptococcal infection affecting the pharynx, lower lip, and gingiva of a healthy 19-year-old male is presented.

RESULTS

The streptococcal infection was responsive to penicillin treatment.

CONCLUSIONS

In view of the increased use of antibiotics and the development of aggressive strains, the dental clinician has to consider streptococcal infection in the differential diagnosis of gingival and soft tissue infections.

Labial tuberculosis: a unique cause of lip swelling complicating HIV infection

BACKGROUND

HIV disease has many oral manifestations including tuberculosis, which most commonly presents as irregular ulceration of the tongue or the palate. We detail an HIV-infected patient found to have tuberculosis of the lip.

CONCLUSIONS

To our knowledge tuberculosis of the lips has never been reported in conjunction with HIV infection, and in this case establishing the oral diagnosis resulted in the diagnosis of disseminated disease.

Down syndrome: lip lesions (angular stomatitis and fissures) and Candida albicans

BACKGROUND

The incidence of angular cheilitis (angular stomatitis, perleche, commissural fissures) appears to be increased in people with Down syndrome (DS). Lip fissures are also (in our clinical impression) a fairly regular feature, yet this is scarcely mentioned in the literature.

OBJECTIVES

To establish the incidence of angular cheilitis and lip fissures in a substantial group of patients with DS and to examine the relationship with Candida albicans.

PATIENTS AND METHODS

The prevalence of orofacial soft tissue lesions was investigated in a group of 77 DS patients. Swabs were taken from lip lesions, palate and tongue and inoculated on Sabouraud's agar discs for the isolation of C. albicans, identified with commercially available kits.

RESULTS

Lip fissures were seen in at least one-quarter of DS patients. Angular cheilitis was also found in a similar percentage.

CONCLUSIONS

C. albicans was isolated from a substantial proportion of lesions tested, and was present more frequently than in those without lip lesions, but it is uncertain whether this represents cause or effect.

A rare case of lip ulcer infected by Klebsiella pneumoniae: case report

The aetiology of mouth ulcers is diverse and may include several types of trauma, systemic disease and infection. The size, depth, outline, base, aspect of the floor, pain, time of evolution and resolution of oral ulcers are discussed. Both past and present medical history, biopsy, blood tests and microbiological tests are also considered in order to assure precise identification. This paper reports a case of a lip ulcer caused by Klebsiella pneumoniae.

[The choice of fungicidal preparations for the treatment of candidiasis of the oral mucosa and lips]

Therapeutic efficacies of various antifungal agents are assessed in 461 patients. A new method for assessing the sensitivity of Candida to various fungicidal drugs is described, permitting a rapid proper choice of the drug for treating oral candidiasis.

Locally invasive oral candidiasis mimicking zygomycosis in a patient with diabetic ketoacidosis

Candida species are increasingly assuming a pathogenic role in patients throughout the spectrum of in competence. This case history documents a unique presentation of candidiasis with marked similarity to the zygomycoses in patients with diabetic ketoacidosis and explores the pathogenetic basis for both.

Actinomycosis--an unusual presentation

We report an unusual presentation of orofacial actinomycosis mimicking the clinical appearance of a minor salivary gland tumour of the upper lip. Histological examination confirmed the diagnosis and we think that the lesion was caused by infection of a mucocele of the upper lip by Actinomyces israelii, an oral commensal.

Botryomycosis in the acquired immunodeficiency syndrome

Botryomycosis is a rare bacterial infection that may mimic fungal disease both clinically and histologically. Cutaneous botryomycosis is uncommon and usually appears as plaques with superficial pustules and crusts. On microscopic examination lesions are characterized by the presence of granules that resemble the sulfur granules of actinomyces with a granulomatous inflammatory response. An increased incidence has been reported in populations with altered immune function and the presentation may be atypical in patients with the acquired immunodeficiency syndrome. We report the successful treatment of a case of mucocutaneous botryomycosis in a patient with acquired immunodeficiency syndrome. A review of the literature is presented, with special emphasis on cutaneous manifestations of botryomycosis in patients with acquired immunodeficiency syndrome.

[The role of microorganisms in the genus Staphylococcus in the origin and development of nasal furuncles]

It is shown that Staphylococcus aureus carriage in the nasal mucosa and nasal furuncle risk are related. The severity of nasal furunculosis depends much on the spectrum of biological and virulent characteristics of the microorganism. It is recommended to determine pathogenetic potential of the causing agent by comprehensive examination of its virulence.

Concurrent oral cytomegalovirus and herpes simplex virus infection in association with HIV infection. A case report

Recurrent oral herpes simplex virus lesions are common in both immunocompetent and immunocompromised persons. In contrast, cytomegalovirus-associated intraoral lesions are rarely seen, even in the immunocompromised host. We report a case of concurrent oral herpes simplex virus and cytomegalovirus infection, appearing as an ulcerative lesion of the labial mucosa in a patient with acquired immunodeficiency syndrome. Herpes simplex virus type 1 was shown to be present in the lesion by culture tests, histopathologic examination, immunohistochemistry findings and a direct immunofluorescence assay, and cytomegalovirus by histopathologic examination and immunohistochemistry findings. We deduce that the lesion was due to concurrent herpes simplex virus-1 and cytomegalovirus infection. The patient responded well to 2 weeks of treatment with a high dose of acyclovir.

[Spirochetes in the cheilits granulomatosa and sarcoidosis]

Homogenate of seven cases of cheilits granulomatosa (CG), one case of Melkersson-Rosenthal syndrome (MRS) and one case of sarcoidosis (Sar) were found to have Borrelia underdark field microscope. CG culture of lip tissue of 2 cases showed Borrelia. Detection of anti-Borrelia Burgdorferi (BB)-antibody in serum showed that 8 (82%) of 11 cases of CG were positive, 3 (75%) of 4 cases of MRS and one case of Sar were positive. Histopathological changes in all cases were consistent with the pathological changes caused by spirochetes infection. The results confirmed that there is Borrelia in CG, MRS and Sar, which are spirochetes infected diseases.

Nasofacial zygomycosis

Zygomycosis is an uncommon polymorphic fungal disease. One clinical subtype, nasofacial zygomycosis, is caused by infectious exposure to the organism Conidiobolus coronatus. A case affecting the nose and lips of a 42-year-old Malay man is reported here. The clinicopathologic features and management of this disease are described, and its differential diagnosis is discussed.

Oral melanotic macules in patients infected with human immunodeficiency virus

A group of 217 patients seropositive for human immunodeficiency virus (HIV) were studied for 2 years, during which time pigmented lesions of the oral mucosa developed in 14 (6.4%) of them. The lesions were well circumscribed in some cases and diffuse in others. In some patients the macules enlarged or recurred after surgical excision. In two patients the macules appeared during the administration of zidovudine. Clinical and laboratory evidence of adrenal insufficiency was not detected in any of the patients examined. The histologic appearances were those of melanotic macules. No ultrastructural alterations of the melanocytes were observed. Two of these macules also contained Epstein-Barr virus, and in one case normal oral mucosa was examined and also contained Epstein-Barr virus in the epithelial cells. As a control group we examined 180 health care workers who did not belong to any risk category, and 30 intravenous drug abusers who tested seronegative to HIV. Oral melanotic pigmentation was found in eight of the control subjects (3.6%). The difference was not statistically significant (p = 0.3097). Our study shows that oral macules do not occur more frequently in HIV-infected patients. However, the clinical behavior of these lesions appears to be different during the course of HIV infection. In some HIV-infected patients the cause of the macules might relate to the administration of zidovudine and antifungal or antibacterial drugs. In others the cause remains unknown and could be due to multiple factors.

Juvenile juxtavermilion candidiasis: yet another form of an old disease?

Five cases of a chronic, self-limiting Candida albicans infection of the lip vermilion and juxtavermilion skin in young persons are presented. These infections typically appeared as erythematous, pruritic, yellow crusting plaques of the juxtavermilion skin, with or without desquamation of vermilion surfaces. Evidence of intraoral candidiasis, especially loss of filiform lingual papillae, was present in several cases. The disorder mimics the early stage of chronic mucocutaneous candidiasis but remains within a few millimeters of the mucocutaneous junction and affected individuals appear (with a possible exception) to be immune competent. Mild trauma apparently triggers the infection. The authors emphasize that a scientifically sound cause-and-effect relationship between this new disease and Candida albicans is not herein established and present these cases in the hope that others will thereby be identified and a firmer causal relationship be established.

Human papillomavirus type 2 DNA in oral and labial verruca vulgaris

Twenty instances of verruca vulgaris, equally divided between oral mucosa and lip vermillion, were assayed for the presence of human papillomavirus (HPV) capsid antigen and type-specific DNA employing in situ hybridization methods. All 10 cases arising on lip vermillon expressed capsid antigen and harbored HPV Type 2 genomes as assessed under conditions of high stringency DNA hybridization. Oral verrucae rarely expressed capsid antigen; HPV Type 2 genomes were encountered in 20% of the cases.

Identification of human papillomavirus types in oral verruca vulgaris

Eleven oral verruca vulgaris specimens were examined for the presence of papillomavirus structural antigens by reaction with antibody to type-common antigens and detection by the avidin-biotin-peroxidase complex method. The specimens were also examined by in situ hybridization with biotin-labelled human papillomavirus (HPV) DNA to determine the specific HPV types present in the lesions. Six of the 11 specimens were positive for papillomavirus structural antigens. Of these 6, 5 hybridized to the HPV Type 2 (HPV2) probe and one to the HPV4 probe.

Immune responses to labial infection of BALB/c mice with herpes simplex virus type 1

The kinetics of appearance of five humoral antibody responses (micro-neutralization assay [NT], complement fixation [CF], enzyme-linked immunosorbent assay [ELISA], radioimmunoassay [RIA], antibody-dependent cell-mediated cytotoxicity [ADCC]), were compared during labial infection of BALB/c mice with herpes simplex virus type 1 strain Patton. The ELISA/RIA antibody responses were present in most mice by day 5 after infection, at the beginning of the herpetic lip lesions; antibody effective in ADCC showed identical early kinetics. In contrast, NT/CF antibodies were not detected in most mice until day 10, at the time of resolution of the herpetic lip lesions. The humoral immune responses persisted for at least 6 months after infection. The NT and CF responses were closely correlated in time of appearance and titers (r = 0.9), as were the ELISA and RIA responses (r = 0.99). However, there was little correlation between NT/CF and ELISA/RIA responses (r = 0.02). The kinetics of the delayed type hypersensitivity response showed similar kinetics of appearance to the ELISA/RIA/ADCC humoral responses, and peaked similarly, but waned gradually over 2 months. The importance of antibody in protection against labial herpes simplex virus type 1 infection was demonstrated by the ability of passively transferred convalescent serum (that produced a minimum NT titer of 10 in recipient mice) to protect against development of herpetic lesions and death.

The role of Candida albicans in the pathogenesis of angular cheilosis

It was concluded from the results of this study that: 1. The incidence of chronic C. albicans infection is greater than previously believed. 2. Angular cheilosis and denture sore mouth are often found together. The etiology of both lesions is C. albicans. 3. Systemic factors may be responsible for intraoral candidiasis, but they are of secondary importance in the etiology of angular cheilosis. The primary etiologic agent is C. albicans. 4. Nutritional deficiency or reduced vertical dimension of occlusion are contributing factors in the pathogenesis of angular cheilosis, but C. albicans is the agent primarily responsible for the lesions.

Eikenella corrodens: a new pathogen

Oral infections that result from trauma or dental manipulation are often thought to be of minor importance to the practicing clinician. The majority of oral infections respond well to treathis form of simple therapy is no longer as efficacious as it has been though to be. Soment with the common antibiotics without the need for laboratory culture and sensitivity. There are instances, becoming increasingly frequent, when this form of simple therapy is no longer as efficacious as it has been thought to be. Some exotic infections are frequently recalcitrant to treatment. These infections are usually caused by ubiquitious organisms, such as Eikenella corrodens. We are presenting several of our cases that were caused by this organism, as well as a review of some aspects of its microbiology, in order to attract the attention and interest of our colleagues in dental practice to this increasingly frequent problem.

Effect of pyran on latency after herpes simplex virus infections

The immunomodulator pyran protected mice against both herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) infections. In infections of the lip with HSV-1, prophylactic administration of pyran reduced the severity of the herpetic lesions and enhanced their resolution, but did not decrease the high incidence of development of latent HSV-1 infection of the trigeminal ganglia. In vaginal infections with HSV-2, prophylactic administration of pyran either systemically or locally reduced mortality, reduced the incidence of mice with vaginal HSV-2 infection, and did not alter the low incidence of latent infection of the spinal dorsal root ganglia. Pyran treatment before systemic herpetic infection after intravenous inoculation of HSV-2 also reduced mortality and virus replication, as evidenced by a decreased antibody response in the survivors, and it either reduced latent infection in the spinal dorsal root ganglia or did not predispose mice to latent infection. Treatment with the immunomodulator appeared to inhibit or reduce HSV infection early in viral pathogenesis in all three model systems, producing protection from clinical disease and resulting in less virus to induce a systemic antibody response, with either a reduction in latent virus infection or no enhancement of development of latency. In all of the HSV models, the development of latent herpetic infection was closely correlated with sufficient virus replication early in the infection to induce a systemic neutralizing-antibody response.

[Symptom: changes at the corners of the mouth (author's transl)]

The multiplicity of the pathological changes discussed have already been called many names: rhagades, perlèche, angular cheilosis, interlabial mycosis. It is often a poly-etiologic disease picture the causes of which must be recognized and then if necessary be clarified in greater detail by close interdisciplinary cooperation. Beside the common internal and dermatological diseases which may lead to changes at the angles of the mouth it is intended to show which dental and stomatological considerations are to be included in the differential diagnosis and therapy of this symptom complex.