Oral Cues to Disease

1. A 21-year-old man complains of prolonged diarrhea with steady abdominal pain and recent weight loss. He also reports painful knee and hip joints and generalized fatigue. Physical exam reveals fissure-like ulcerations of the mandibular buccal vestibule and localized abdominal pain with fullness in the right lower quadrant.

Diagnosis: Crohn disease can affect the gastrointestinal tract anywhere from the mouth to the anus, and can manifest with oral findings that may not correlate with abdominal symptoms (eg, mucosal cobble stoning, mucosal tags, deep linear ulcerations, gingival hyperplasia, lip fissuring, aphthous ulcers, angular cheilitis). Other features may include diffuse, painless swelling of the lips and mucosal erythema.

For more information, see “Oral lesions you can’t afford to miss.” J Fam Pract. 2015;64(7):392-399.

2. Over the past few months, this 43-year-old woman has had multiple severely painful, slow-healing oral ulcers, resulting in the erosion of the lower lip. She reports pain on swallowing and occasional bloody nose after blowing in the morning.

Diagnosis: Vesiculo-bullous lesions in the mouth may be seen with pemphigus vulgaris or bullous pemphigoid. Pemphigus vulgaris, an autoimmune intraepithelial blistering disease, often manifests as flaccid bullae or painful ulcerations in the oral cavity prior to the onset of skin lesions.

For more information, see “Oral lesions you can’t afford to miss.” J Fam Pract. 2015;64(7):392-399.

3. A 26-year-old woman presents with fever and fatigue, as well as arthralgia in her hands. Upon examination, she has a malar rash and lichenoid inflammation of the buccal mucosa. She has a family history of autoimmune disorders.

Diagnosis: Oral findings suggestive of systemic or discoid lupus erythematosus may greatly resemble those of oral lichen planus.

For more information, see “Oral lesions you can’t afford to miss.” J Fam Pract. 2015;64(7):392-399.

4. This 14-year-old girl is concerned about the multiple ecchymoses and thrombi in her mouth. She feels fatigued and has a fever. Her history includes a tendency to bruise easily, menorrhagia, and a recent infection treated with vancomycin. Physical exam is notable for retinal hemorrhages and jaundice.

Diagnosis: Thrombocytopenia purpura may manifest with oral petechiae, purpura, oral hematomas, or hemorrhagic bullae.

For more information, see “Oral lesions you can’t afford to miss.” J Fam Pract. 2015;64(7):392-399.

1. A 21-year-old man complains of prolonged diarrhea with steady abdominal pain and recent weight loss. He also reports painful knee and hip joints and generalized fatigue. Physical exam reveals fissure-like ulcerations of the mandibular buccal vestibule and localized abdominal pain with fullness in the right lower quadrant.

Diagnosis: Crohn disease can affect the gastrointestinal tract anywhere from the mouth to the anus, and can manifest with oral findings that may not correlate with abdominal symptoms (eg, mucosal cobble stoning, mucosal tags, deep linear ulcerations, gingival hyperplasia, lip fissuring, aphthous ulcers, angular cheilitis). Other features may include diffuse, painless swelling of the lips and mucosal erythema.

For more information, see “Oral lesions you can’t afford to miss.” J Fam Pract. 2015;64(7):392-399.

2. Over the past few months, this 43-year-old woman has had multiple severely painful, slow-healing oral ulcers, resulting in the erosion of the lower lip. She reports pain on swallowing and occasional bloody nose after blowing in the morning.

Diagnosis: Vesiculo-bullous lesions in the mouth may be seen with pemphigus vulgaris or bullous pemphigoid. Pemphigus vulgaris, an autoimmune intraepithelial blistering disease, often manifests as flaccid bullae or painful ulcerations in the oral cavity prior to the onset of skin lesions.

For more information, see “Oral lesions you can’t afford to miss.” J Fam Pract. 2015;64(7):392-399.

3. A 26-year-old woman presents with fever and fatigue, as well as arthralgia in her hands. Upon examination, she has a malar rash and lichenoid inflammation of the buccal mucosa. She has a family history of autoimmune disorders.

Diagnosis: Oral findings suggestive of systemic or discoid lupus erythematosus may greatly resemble those of oral lichen planus.

For more information, see “Oral lesions you can’t afford to miss.” J Fam Pract. 2015;64(7):392-399.

4. This 14-year-old girl is concerned about the multiple ecchymoses and thrombi in her mouth. She feels fatigued and has a fever. Her history includes a tendency to bruise easily, menorrhagia, and a recent infection treated with vancomycin. Physical exam is notable for retinal hemorrhages and jaundice.

Diagnosis: Thrombocytopenia purpura may manifest with oral petechiae, purpura, oral hematomas, or hemorrhagic bullae.

For more information, see “Oral lesions you can’t afford to miss.” J Fam Pract. 2015;64(7):392-399.

1. A 21-year-old man complains of prolonged diarrhea with steady abdominal pain and recent weight loss. He also reports painful knee and hip joints and generalized fatigue. Physical exam reveals fissure-like ulcerations of the mandibular buccal vestibule and localized abdominal pain with fullness in the right lower quadrant.

Diagnosis: Crohn disease can affect the gastrointestinal tract anywhere from the mouth to the anus, and can manifest with oral findings that may not correlate with abdominal symptoms (eg, mucosal cobble stoning, mucosal tags, deep linear ulcerations, gingival hyperplasia, lip fissuring, aphthous ulcers, angular cheilitis). Other features may include diffuse, painless swelling of the lips and mucosal erythema.

For more information, see “Oral lesions you can’t afford to miss.” J Fam Pract. 2015;64(7):392-399.

2. Over the past few months, this 43-year-old woman has had multiple severely painful, slow-healing oral ulcers, resulting in the erosion of the lower lip. She reports pain on swallowing and occasional bloody nose after blowing in the morning.

Diagnosis: Vesiculo-bullous lesions in the mouth may be seen with pemphigus vulgaris or bullous pemphigoid. Pemphigus vulgaris, an autoimmune intraepithelial blistering disease, often manifests as flaccid bullae or painful ulcerations in the oral cavity prior to the onset of skin lesions.

For more information, see “Oral lesions you can’t afford to miss.” J Fam Pract. 2015;64(7):392-399.

3. A 26-year-old woman presents with fever and fatigue, as well as arthralgia in her hands. Upon examination, she has a malar rash and lichenoid inflammation of the buccal mucosa. She has a family history of autoimmune disorders.

Diagnosis: Oral findings suggestive of systemic or discoid lupus erythematosus may greatly resemble those of oral lichen planus.

For more information, see “Oral lesions you can’t afford to miss.” J Fam Pract. 2015;64(7):392-399.

4. This 14-year-old girl is concerned about the multiple ecchymoses and thrombi in her mouth. She feels fatigued and has a fever. Her history includes a tendency to bruise easily, menorrhagia, and a recent infection treated with vancomycin. Physical exam is notable for retinal hemorrhages and jaundice.

Diagnosis: Thrombocytopenia purpura may manifest with oral petechiae, purpura, oral hematomas, or hemorrhagic bullae.

For more information, see “Oral lesions you can’t afford to miss.” J Fam Pract. 2015;64(7):392-399.