Oral ulcers in a finger‐sucking child after cutaneous wart therapy

2021 ◽  
Author(s):  
Jennifer McConnell ◽  
Lindsey Claire Epperson ◽  
Faye Eifert ◽  
Kim Aldy
Keyword(s):  
Oral Ulcers ◽  
Cutaneous Wart

AYURVEDIC PREPARATIONS FOR THE MANAGEMENT OF THE RAS - A REVIEW

2020 ◽  
Vol 7 (9) ◽  
pp. 1-8
Keyword(s):  
General Population ◽  
Herbal Medicines ◽  
Sudden Increase ◽  
Herbal Extracts ◽  
Common Condition ◽  
Etiological Factors ◽  
Oral Ulcers ◽  
Alternative Approach

Oral ulcers are the most common condition in the general population and are caused by a variety of etiological factors. It often causes pain and discomfort. So, there are different treatments including herbal medicines that have been used for oral ulcers. Nowadays, there has been a sudden increase in the use of herbal extracts as an alternative approach to modern-day medicines. So, this review focuses on the ayurvedic preparations for the treatment of RAS.

A Rare Case Report of Dabigatran Induced Oral Ulcers

2020 ◽  
Vol 15 (2) ◽  
pp. 160-162
Author(s):  
Ajeet Singh ◽  
Neel Prabha ◽  
Hitesh Yadav
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Warfarin Therapy ◽  
Systemic Embolism ◽  
Vein Thrombosis ◽  
Oral Ulcers ◽  
Retrosternal Pain ◽  
Novel Oral Anticoagulant ◽  
Rare Case Report ◽  
Deep Vein

Background: Dabigatran is a novel oral anticoagulant molecule which is a direct thrombin (Factor IIa) inhibitor and is used for prevention of stroke and systemic embolism. It is easy to administer as compared to warfarin therapy as it does not require routine laboratory monitoring and has fewer drug interactions. Objective: To present a rare case of oral ulcers secondary to dabigatran in a patient with deep vein thrombosis. Case report: A 68-year-old female presented with painful oral ulcers, retrosternal pain and difficulty in swallowing. She had been taking capsule Dabigatran for the prevention of systemic embolism for 2 months. She had experienced symptoms of onset taking dabigatran for 7 days. Clinical examination revealed three tender, well-defined, clean looking ulcers of various sizes present over the dorsum of the tongue. Dabigatran was withdrawn and the patient was on oral proton pump inhibitors. Patient showed remarkable improvement in oral ulcers after 2 weeks. Conclusion: Patient education and counseling should be done regarding this side effect of dabigatran and proper intake of this medicine.

scholarly journals When systemic lupus erythematosus affects vision: a rare presentation of this condition

2020 ◽  
Vol 13 (1) ◽  
pp. e229382
Author(s):  
Tiago Gama Ramires ◽  
Luísa Vieira ◽  
Nuno Riso ◽  
Maria Francisca Moraes-Fontes
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Blurred Vision ◽  
Rare Presentation ◽  
Complement Components ◽  
Oral Ulcers ◽  
Dsdna Antibody ◽  
Rare Manifestation ◽  
Retinal Vascular Tortuosity

A 23-year-old woman with fever, oral ulcers, arthalgias and weight loss of 2-week duration suddenly developed blurred vision, with reduced visual acuity, cotton wool exudates and retinal vascular tortuosity. Laboratory testing revealed anaemia, lymphopaenia, positive antinuclear antibody and high anti-dsDNA antibody titre with low complement components. There was no evidence of infection, clinching the diagnosis of lupus retinopathy. Steroid therapy alone was highly effective and was also accompanied by a normalisation of haemoglobin and lymphocyte counts, after which azathioprine was added. Hydroxychloroquine was introduced after resolution of retinal changes. Immunosuppressive therapy was progressively tapered over the course of 12 months and then discontinued, and the patient remains in remission 48 months after the initial presentation. Our patient exemplifies a very rare manifestation of systemic lupus erythematosus. We emphasise the importance of its early detection and complexity of treatment in order to reduce visual morbidity.

scholarly journals AB0786 HUGHES–STOVIN SYNDROME: A PECULIAR AUTOIMMUNE ORIGIN OF PULMONARY ANEURYSMS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1418.2-1419
Author(s):  
P. Triggianese ◽  
A. D’antonio ◽  
B. Kroegler ◽  
A. Ascoli Marchetti ◽  
L. Belvivere ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Ct Angiography ◽  
Early Recognition ◽  
Endovascular Embolization ◽  
Ocular Involvement ◽  
Arterial Aneurysm ◽  
Filter Placement ◽  
Invasive Approach ◽  
Oral Ulcers

Background:Hughes-Stovin Syndrome (HSS) is a rare potentially fatal vasculitis supposedly belonging to the spectrum of Behçet disease without ocular involvement. HSS tends to play by a temporal pattern, starting with thrombosis and followed by formation of pulmonary aneurysms. Since its mortality can reach 25% of cases, the early recognition and the appropriate therapy represent the major challenges.Objectives:In this report, we aimed at describing a rare case of HSS successfully treated in accordance with a prompt combined management with endovascular approach and immunosuppressive treatments.Methods:We described a Caucasian 33-year-old man presented to the Emergency Room of our Hospital with hemoptysis associated with dyspnea and chest pain, without fever and hypotension, with a 2-year history of painful genital and oral ulcers. Blood test revealed anemia, elevated white cell count with increased C-reactive protein (77 mg/L) and D-dimer (2740 ng/mL). Doppler ultrasonography of legs showed thrombosis of the left femoral vein, while CT-angiography reported multiple aneurysms of the pulmonary arteries. An early and extensive work-up for infections and autoimmunity did not document relevant abnormalities. An appropriate genetic assessment revealed the HLA-B51 positivity. The patient immediately underwent endovascular embolization with coils and plugs of the largest pulmonary aneurysm, and inferior vena cava filter placement. Then, he started methylprednisolone (1 mg/kg/day) IV for three days in association with LMWH (6000 IU/day). Prednisone (1 mg/kg/day) in combination with cyclophosphamide (100 mg daily) were started orally, with tapering of steroids within a month. At the tight follow up (1 month and 3 months later), no genital and oral ulcers nor vascular thrombosis occurred, and acute phase reactants were in normal range. The 3-month-CT angiography showed a complete resolution of the aneurysms and no new changes.Results:The peculiar diagnosis of HLAB51 positive HSS with multiple pulmonary aneurysms was made. The appropriate imaging followed by a prompt endovascular embolization of aneurysms with LMWH treatment were successfully performed. Interestingly, the oral combination therapy with corticosteroid and cyclophosphamide showed a rapid efficacy with a relevant safety profile. At the tight follow up, the young man improved significantly with clinical signs and pulmonary changes (Figure 1 next page).Conclusion:This case is of interest because of the early recognition of such a rare disease that allowed an adequate combined radiological, vascular, and rheumatologic approach. In our case, LMWH resulted useful in preventing the pulmonary embolism, despite the use of anticoagulants is still debated in HSS. Moreover, the endovascular embolization let a less invasive approach to surgery without the need for multiple surgical procedures. For the first time, we documented that oral cyclophosphamide showed an early efficacy as a first line therapy of a HLA-B51 HSS.References:[1]Keskin M, Polat G, Ayranci A, et al. Insidious Hughes Stovin Syndrome: Journey From Pulmonary Embolism to Pulmonary Arterial Aneurysm. Turk Thorac J. 2020;21:350-353.[2]Valdés-Corona LF, Kimura-Hayama E, Méndez-Cano VH, et al. Hughes-Stovin syndrome: an uncommon cause of pulmonary aneurysms. Rheumatology (Oxford). 2020;59:2183-2184.Figure 1.Disclosure of Interests:None declared

Firm swelling of the lips and aphthouslike oral ulcers associated with new-onset allergies

2021 ◽  
Author(s):  
Megan E. Bunting ◽  
Jennifer B. Hawie ◽  
Douglas D. Lancaster ◽  
Thomas M. Johnson
Keyword(s):  
Oral Ulcers ◽  
New Onset

scholarly journals OP0028 EFFICACY OF APREMILAST FOR THE PAIN OF ORAL ULCERS ASSOCIATED WITH ACTIVE BEHÇET’S SYNDROME: 12-WEEK RESULTS FROM THE RANDOMIZED, PHASE III RELIEF STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 20.2-21
Author(s):  
G. Hatemi ◽  
A. Mahr ◽  
M. Takeno ◽  
D. Kim ◽  
M. Melikoglu ◽  
...  
Keyword(s):  
Phase Iii ◽  
Controlled Study ◽  
Behçet’S Syndrome ◽  
Research Support ◽  
Behçet's Syndrome ◽  
Oral Ulcers ◽  
Behcet’S Syndrome ◽  
Vas Scores ◽  
The Mean ◽  
Behcet's Syndrome

Background:Oral ulcers (OU) associated with Behçet’s syndrome are often painful, may interfere with the ability to eat and can negatively affect quality of life.1,2Apremilast (APR), an oral phosphodiesterase 4 inhibitor, demonstrated efficacy in the treatment of OU associated with Behçet’s syndrome in a phase III, multicenter, randomized, double-blind, placebo (PBO)-controlled study (RELIEF; BCT-002).3Objectives:To describe the efficacy of APR treatment in improving OU pain associated with Behçet’s syndrome in RELIEF.Methods:Patients were randomized (1:1) to APR 30 mg twice daily (APR 30 BID) or PBO twice daily for a 12-week PBO-controlled phase, followed by a 52-week active treatment extension. Eligible patients were ≥18 years of age and had active Behçet’s syndrome with ≥3 OU at randomization or ≥2 OU at screening and randomization and without active major organ involvement. Clinical improvement in OU was evaluated by the area under the curve for the number of OU through Week 12 (AUCWk0-12; primary efficacy endpoint) and by assessments of OU number. Patient-reported OU pain was evaluated by the 100-mm visual analogue scale (VAS). The statistical tests were 2-sided (α=0.05). The proportions of patients achieving the minimal clinically important difference (MCID) and higher rates of improvement, defined as ≥10-mm,4≥30-mm (3-fold MCID), ≥50-mm (5-fold MCID) improvements in OU pain VAS scores, respectively, were analyzed through Week 12. An ANCOVA model was used to analyze the primary endpoint and assessments of OU number and OU pain (VAS). The proportion of patients achieving improvement in OU pain VAS scores at Week 12 were summarized descriptively.Results:A total of 207 patients were randomized and received ≥1 dose of study medication (APR: n=104; PBO: n=103). At baseline, the mean (SD) number of OU was 4.2 (3.7) in the APR 30 BID group and 3.9 (2.7) in the PBO group, and the mean (SD) OU pain VAS scores were 61.2 (27.6) and 60.8 (26.9), respectively. At Week 12, significantly greater improvements were observed with APR 30 BID vs. PBO in AUCWk0-12(least-squares [LS] mean [SE]: 129.5 [15.9] vs. 222.1 [15.9];P<0.0001), number of OU (LS mean [SE]: 1.1 [0.2] vs. 2.0 [0.3];P=0.0003) and OU pain VAS scores (LS mean [SE] change from baseline: −40.7 [3.3] vs. −15.9 [3.3];P<0.0001). The proportion of patients who achieved the MCID of ≥10-mm improvement in OU pain VAS scores at Week 12 was greater with APR 30 BID vs. PBO; this pattern was also observed for the higher 3- and 5-fold improvements in MCID (Figure 1). Greater proportions of APR 30 BID vs. PBO patients achieved ≥10-mm and ≥30-mm improvements in OU pain VAS scores over 12 weeks. Notably, greater achievement of ≥50-mm improvement in OU pain VAS scores was observed with APR 30 BID vs. PBO as early as Week 1 and maintained up to Week 12 (Figure 2).Conclusion:For patients with active Behçet’s syndrome, APR 30 BID provided significantly greater improvements vs. PBO in OU number and OU pain at Week 12, including the greater proportion of patients achieving MCID and 3- and 5-fold MCID of OU pain in the APR 30 BID group vs. the PBO group. These results indicate a clinically meaningful treatment effect of APR 30 BID on the OU associated with Behçet’s syndrome.References:[1]Kokturk A.Patholog Res Int. 2012;2012:690390.[2]Hatemi G, et al.Ann Rheum Dis. 2008;67:1656-1662.[3]Hatemi G, et al.N Engl J Med. 2019;381:1918-1928. 4. Dworkin RH, et al.J Pain. 2008;9:105-121.Disclosure of Interests:Gulen Hatemi Grant/research support from: BMS, Celgene Corporation, Silk Road Therapeutics – grant/research support, Consultant of: Bayer, Eli Lilly – consultant, Speakers bureau: AbbVie, Mustafa Nevzat, Novartis, UCB – speaker, Alfred Mahr Consultant of: Celgene, Speakers bureau: Roche, Chugai, Mitsuhiro Takeno Speakers bureau: Esai, Tanabe-Mitsubishi – speaker; Celgene Corporation – advisory board, Doyoung Kim: None declared, Melike Melikoglu: None declared, Sue Cheng Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Shannon McCue Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Sven Richter Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Michele Brunori Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Maria Paris Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Mindy Chen Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of the conduct, Yusuf Yazici Consultant of: BMS, Celgene Corporation, Genentech, Sanofi – consultant, Consultant of: BMS, Celgene Corporation, Genentech, Sanofi – consultant

scholarly journals SAT0539 MUCKLE-WELLS SYNDROME IN RHEUMATOLOGY PRACTICE, FAMILY CASES: FEDERAL CENTER EXPERIENCE.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1227.1-1227
Author(s):  
S. Salugina ◽  
E. Fedorov ◽  
K. Elena ◽  
E. Zakharova ◽  
S. Palshina
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Autoinflammatory Disease ◽  
Family Members ◽  
Sensorineural Hearing ◽  
Nlrp3 Gene ◽  
Oral Ulcers ◽  
Family Medical History ◽  
Wells Syndrome ◽  
Rheumatology Practice

Background:Muckle-Wells syndrome (MWS) is a monogenic autoinflammatory disease caused by a NLRP3 gene mutation. It is the most common variant of cryopyrin-associated periodic syndromes (CAPSs) and can be observed in rheumatology practice. It manifests itself in fever, urticaria-like rash, arthralgias/arthritides, conjunctivitis/uveitis, sensorineural hearing loss, acute-phase markers (ESR, CRP). The disease’s onset usually takes place in infancy. There are examples of family cases. Targeted therapy: interleukin-1 inhibitors (anakinra, canakinumab).Objectives:to provide characteristics of MWS patients, family cases in the rheumatology practice of the Federal Rheumatology Center in Russia.Methods:in a 10-year period (2009 to 2019), MWS was diagnosed in 42 outpatient and inpatient patients, among them were 24 children, 18 adults, and 9 family cases. All of them underwent a standard rheumatology examination, including a ECR, CRP, ophthalmologist examination, and an audiogram. A molecular genetic test of the NLRP3 gene was carried out for all patients, the diagnosis was confirmed in all of them.Results:Out of 18 adult patients aged between 19 and 59 years, women were prevalent (16 to 2), the onset age was 0 to 53 years, in 88,9% cases the onset took place before a patient was 18 years old. When diagnosed, the disease duration varied from 6 to 46 years. Most patients demonstrated fever, urticarial-like rash, arthralgias/arthritides, which were observed in 16 patients (88.9%), conjunctivitides were observed in 15 patients (83,3%), sensorineural hearing loss – in 8 patients (44,4%), abdominal pain, nausea, vomiting – in 4 patients, headache, dizziness – in 6 patients. There also were rare manifestations, such as: recurrent oral ulcers (8), genital ulcers (3), erythema nodosum (3), sore throat and raids on the tonsils (PFAPA-like phenotype) was observed in 2 patients. In 3 patients manifestations were triggered by cold temperature. All patients had an increased ESR and C-reactive protein concentration. Eight family cases of MWS were identified (in total 26 family members aged between 2.5 and 62 years) with a number of affected in one family ranging from 2 to 6 people of different age (8 children, 18 adults, out of which 20 were female, and 6 were male). Most patients had fever (17), urticarial-like rash (18), conjunctivitides (12), oral ulcers (7), articular syndrome (14), sensorineural hearing loss (5), and 2 patients died of renal insufficiency (probably due to amyloidosis of the kidneys). The heterozygous mutations in NLRP3 have been identified in pts: T348M (3 families), R262W (2 families), A439V (1), V198M (1), Pro294Ser (1). Ten patients received canakinumab for a period of 6 months to 6.5 years, and 5 patients received anakinra before canakinumab.Conclusion:MWS is an orphan autoinflammatory disease, however it sometimes can be observed in rheumatology practice. It is very important to acquire family medical history to identify affected family members and prescribe therapy in a timely manner. IL-1 inhibitors are an effective and safe treatment option for MWS patients.Disclosure of Interests:None declared

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