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Turkstani H, Alfaifi A, Ramachandran M, Bushra A, Stoopler E, France K. Severe manifestation of plasma cell mucositis in a patient with autism spectrum disorder: A unique overlap illustrating challenges with diagnosis and management. SPECIAL CARE IN DENTISTRY 2024. [PMID: 39152628 DOI: 10.1111/scd.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/26/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024]
Abstract
Plasma cell mucositis (PCM) is a rare inflammatory condition affecting the oral tissues, often triggered by allergens or inflammation. Autism spectrum disorder (ASD), a neurodevelopmental condition, poses unique challenges in oral care and hygiene due to behavioral and sensory issues. These conditions have not previously been reported in concert but may share risk factors including through the development of inflammation. We present a case of severe PCM in a 23-year-old male with ASD, illustrating diagnostic complexities and management strategies. The patient presented with widespread and severe lesions, raising the possibility of underlying causes. After multiple interventions, including topical steroids and trigger avoidance, the patient achieved near-complete resolution of the oral lesions. Immunohistochemical and serological investigations suggested an underlying monoclonal gammopathy, warranting hematological evaluation. Our case shows how PCM and ASD can affect each other, highlighting the importance of understanding how these conditions interact, and the need for tailored approaches to oral health in this population. Further research is needed to elucidate any pathophysiological or risk-based link between ASD and inflammatory oral conditions and to refine management strategies for PCM in patients with neurodevelopmental disorders.
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Affiliation(s)
- Heba Turkstani
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Afrah Alfaifi
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maya Ramachandran
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ahmedi Bushra
- Access Dental Associates, BrookHaven, Pennsylvania, USA
| | - Eric Stoopler
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katherine France
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gonçalves LSS, Martins KH, Reyes MRT, Catananti IS, Chahud F, León JE. Light-chain-restricted Russell body oral mucositis: an immunohistochemical study and literature review. Leuk Lymphoma 2024; 65:1190-1193. [PMID: 38638066 DOI: 10.1080/10428194.2024.2342564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 12/28/2024] [Accepted: 01/08/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Luana Stefanie Silvino Gonçalves
- Department of Pediatric Dentistry - Riberão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Karina Helen Martins
- Department of Pediatric Dentistry - Riberão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Magdalena Raquel Torres Reyes
- Department of Pediatric Dentistry - Riberão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Isabella Silva Catananti
- Department of Pediatric Dentistry - Riberão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fernando Chahud
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jorge Esquiche León
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Oral Pathology, Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP), University of São Paulo, Avenida do Café, Ribeirão Preto, São Paulo, Brazil
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Viedma-Martinez M, Gallo-Pineda G, Recio-Monescillo M, Jimenez-Gallo D, Lopez-Sanz P, Drake-Monfort M, Urigoitia-Ugalde P, Martínez-Signes V, Llorca-Juan D, Fuertes-Vega L, Ríos-Viñuela E, Escario-Travesedo E, Ríos-Martín JJ, Requena-Caballero L, Linares-Barrios M. Retrospective Case Series of Cocaine-Associated Plasma Cell Orificial Mucositis. JAMA Dermatol 2024; 160:320-327. [PMID: 38265770 PMCID: PMC10809139 DOI: 10.1001/jamadermatol.2023.5692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/15/2023] [Indexed: 01/25/2024]
Abstract
Importance Plasma cell orificial mucositis (PCOM) associated with cocaine use is an emerging, rare condition that has become a concern in Spain in recent years. Limited knowledge exists regarding this novel condition. Objectives To delineate the clinicopathologic characteristics of this emerging entity and establish a novel approach in the differential diagnosis of cocaine-associated lesions. Design, Setting, and Participants A descriptive, retrospective, multicenter case series of 10 patients diagnosed with cocaine-associated PCOM was conducted in Spain from April 2020 to March 2023. Main Outcomes and Measures Patient demographic, clinical, histopathologic, and treatment data were collected. Results A total of 10 patients (6 [60%] male; median [range] age, 45.5 [36-66] years) presenting with exudative ulcerated plaques were identified for this study. The lesions had raised and erythematous edges over the nostril and a median (range) evolution time of 9 (2-24) months. Septal or palate perforations were observed in 4 (40%) of the patients. Biopsies revealed a dense inflammatory infiltrate of plasma cells in the dermis without atypia and with eosinophils. All patients reported recent cocaine use. Three urine tests detected cocaine but found no presence of amphetamines or opiates. Six patients improved with corticosteroid therapy. Up to 60% of patients were lost to follow-up. Conclusions and Relevance This case series describes the clinicopathologic characteristics of PCOM, an emerging entity associated with cocaine use in Spain, and demonstrates a novel approach in the differential diagnosis of cocaine-associated lesions. To date, cocaine-associated skin lesions have been reported as neutrophilic dermatoses and vasculitis. The appearance of a plasma cell infiltrate changes what has been described in the medical literature so far. PCOM is a benign condition of unknown cause characterized by a proliferative polyclonal plasma cell infiltrate. A comprehensive differential diagnosis workup is required to reach this exclusionary diagnosis. Several irritants have been documented in cases of PCOM, and a hypersensitivity mechanism has been proposed. Since the initial report of cocaine-associated PCOM in Spain, its incidence has experienced a surge in the country. The cause of this phenomenon may be attributed to newly unidentified adulterants. The administration of corticosteroids and discontinuation of cocaine use are the sole treatments that have demonstrated efficacy. Clinicians should be vigilant regarding this emerging condition and conduct inquiries into cocaine use. Additional research is required to clarify the pathophysiology of this emerging condition.
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Affiliation(s)
- Myriam Viedma-Martinez
- Department of Dermatology, Hospital Universitario Puerta del Mar, Cádiz, Andalucía, Spain
| | - Gonzalo Gallo-Pineda
- Department of Dermatology, Hospital Universitario Puerta del Mar, Cádiz, Andalucía, Spain
| | - Miguel Recio-Monescillo
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Madrid, Spain
| | - David Jimenez-Gallo
- Department of Dermatology, Hospital Universitario Puerta del Mar, Cádiz, Andalucía, Spain
| | - Pablo Lopez-Sanz
- Department of Dermatology, Hospital General Universitario De Albacete, Albacete, Castilla La Mancha, Spain
| | - Marta Drake-Monfort
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | | | | | - David Llorca-Juan
- Department of Dermatology, Hospital Universitario De La Ribera, Alzira, Valencia, Spain
| | - Laura Fuertes-Vega
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Madrid, Spain
| | - Elisa Ríos-Viñuela
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Madrid, Spain
| | - Eduardo Escario-Travesedo
- Department of Dermatology, Hospital General Universitario De Albacete, Albacete, Castilla La Mancha, Spain
| | - Juan José Ríos-Martín
- Pathology Department, Hospital Universitario Virgen Macarena, Sevilla, Andalucía, Spain
| | - Luis Requena-Caballero
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Madrid, Spain
| | - Mario Linares-Barrios
- Department of Dermatology, Hospital Universitario Puerta del Mar, Cádiz, Andalucía, Spain
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Fitzpatrick SG, Alramadhan S, Islam MN, Bhattacharyya I. Increased frequency of oral plasma cell mucositis/plasma cell gingivitis after the COVID-19 pandemic: a 23-year retrospective analysis and review of diagnostic challenges relating to this condition. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:153-160. [PMID: 38331651 DOI: 10.1016/j.oooo.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/27/2023] [Accepted: 08/13/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Oral plasma cell mucositis (PCM) or localized plasma cell gingivitis (PCG) is an idiopathic inflammatory condition often associated with hypersensitivity reactions. This study aimed to evaluate the frequency and features of PCM/PCG in a large biopsy service over a time period of more than 20 years. STUDY DESIGN The biopsy archives at University of Florida College of Dentistry were searched from 2000 through the first quarter of 2023 for cases of oral PCM or PCG. Case data were aggregated and analyzed. RESULTS A total of 107 cases were included. Between 2000 and 2019, PCM/PCG was diagnosed in 0.03% of all biopsy cases. Starting in 2020 through 2023, the percentage of biopsies diagnosed as PCM/PCG increased threefold to 0.10% of all biopsy cases, and the mean patient age increased by 3 years. There were no statistically significant differences between cases diagnosed from 2000 to 2019 and those from 2020 to 2023 regarding age, sex, location, or histology. CONCLUSIONS A significant increase in PCM/PCG was identified in this study at one institution coinciding with the start of the COVID-19 pandemic. Further investigation is recommended to determine if this is a widespread phenomenon and identify possible etiologic mechanisms.
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Affiliation(s)
| | - Saja Alramadhan
- University of Florida College of Dentistry, Gainesville, FL, USA
| | - Mohammed N Islam
- University of Florida College of Dentistry, Gainesville, FL, USA
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