Monthly Online Case Presentation of the Osteopathic Dermatology Residency Programs

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Dermatology Discussion

St. John Oakland Hospital

July 2004

Presenters:  Scott C. Wickless, DO; Amy B. Cardellio, DO; Anthony Cardellio, DO
 

Program Director: Amy B. Cardellio, DO


Clinical Presentation

69 year old Caucasian female

History

Chief Complaint: “Painful lesions in the mouth.”
Signs and symptoms: Mild to moderate pain of the mouth and tongue for approximately five years.
Previous Treatment: Semi-controlled with topicals (steroid and antifungal preparations).
Other Information: “Spots” appearing sporadically on the scalp. No history of bone marrow transplant, hematopoietic stem cell transplantation, transfusion of unirradiated blood products or solid organ transplantation.

Physical Examination

Mouth: Buccal and gingival mucosa with numerous violaceous plaques and erosive patches of erythema. Tongue with extensive thick-white violaceous plaques and erosive involvement.
Scalp: Multiple scattered erythematous patches with scale.
Genitalia: Labia with multiple reticulated plaques; sparing of the perineum and rectum.

Dermatohistopathology

Mouth: The sections show irregular mucosal acanthosis. There is a dense
band-like lymphocytic infiltrate with focal hydropic degeneration and rare cytoid
bodies. Representational images courtesy of David Mehregan, MD.

Differential Diagnosis