case_images: PMC11192598_01
case_images: Extraoral examination demonstrated multiple brown macules scattered at the (a) cheek, (b) forehead, (c) neck, and (d) perioral.
case_images: CRID2024-1975932.001.jpg
case_images: PMC11192598_01_CRID2024-1975932.001.jpg
case_images: fig1
case_images: However, in this case, DIF had all negative findings (Supplementary Figure 1).
case_images: The first-visit intraoral examination revealed erythematous areas with white striae at the (a) right buccal mucosa, (b) left buccal mucosa, (c) palate, and (d) depapillated dorsum of the tongue. Pseudomembranous ulcer and erythematous areas with white striae at the (e) right lateral tongue and (f) left lateral tongue.
case_images: CRID2024-1975932.002.jpg
case_images: PMC11192598_01_CRID2024-1975932.002.jpg
case_images: fig2
case_images: For intraoral examination (Figure 2), erythematous areas with white striae were found in several areas, including the lower lip, lower labial mucosa, labial gingiva of lower teeth extending to the mucobuccal fold, buccal gingiva of teeth 15-16 extending to the mucobuccal fold, mucobuccal fold of teeth 45-47, right buccal mucosa (Figure 2(a)), buccal gingiva of tooth 35, interdental papilla of tooth 35/36, left buccal mucosa (Figure 2(b)), mid-palate at the torus palatinus (Figure 2(c)), left side of the dorsum of the tongue (Figure 2(d)), ventral of the tongue (Figures 2(e) and 2(f)), and the floor of the mouth. Pseudomembranous ulcerations at the left buccal mucosa, size 3 x 4 mm2 (Figure 2(b)); the left lateral of the tongue, size 10 x 30 mm2 (Figure 2(f)); and the right ventral of the tongue in the area of teeth 43-45, size 5 x 8 mm2 (Figure 2(e)).
case_images: The microscopic examination reveals an oral mucosa surfaced by parakeratinized stratified squamous epithelium. Chronic inflammatory cell infiltration is observed within the superficial portion of the connective tissue (black arrow). Thick-walled vascular channels, adipose tissues, and muscle bundles are within the deeper portion of the connective tissue at the magnification of (a) 40x and (b) 100x.
case_images: CRID2024-1975932.003.jpg
case_images: PMC11192598_01_CRID2024-1975932.003.jpg
case_images: fig3
case_images: One week later, the result of the incisional biopsy (Figure 3) revealed chronic mucositis similar to lichen planus or lichenoid mucositis but lacking the triad which are band-like infiltrates, irregular acanthosis, and vacuolation of basal cells known as "hallmark of LP".
case_images: The second-visit intraoral examination revealed mild erythematous areas with white striae at the (a) right buccal mucosa, (b) left buccal mucosa, and (c) palate. (d) Depapillated dorsum of the tongue. Pseudomembranous ulcer at the (e) right lateral tongue and (f) left lateral tongue.
case_images: CRID2024-1975932.004.jpg
case_images: PMC11192598_01_CRID2024-1975932.004.jpg
case_images: fig4
case_images: Clinical examination also showed resolving signs, described as a mild erythematous area with white striae at the left and right buccal mucosa (Figures 4(a) and 4(b)); mid-palate (torus palatinus) (Figure 4(c)); and left, right, and depapillated tongue with the erythematous area (Figure 4(d)). Pseudomembranous ulcers still persisted at the left and right lateral of the tongue (Figures 4(e) and 4(f)).
case_images: The third-visit intraoral examination revealed mild white striae and hyperpigmentation at the (a) right buccal mucosa and (b) left buccal mucosa. (c) Mildly depapillated dorsum of the tongue. Normal mucosa at the (d) right lateral tongue and (e) left lateral tongue.
case_images: CRID2024-1975932.005.jpg
case_images: PMC11192598_01_CRID2024-1975932.005.jpg
case_images: fig5
case_images: Clinical examination revealed mild white striae at the right buccal mucosa (Figure 5(a)), white striae at the mucobuccal fold area of teeth 36-37 extending to the left buccal mucosa (Figure 5(b)), mucobuccal fold of teeth 44-47, hyperpigmentation at the left and right buccal mucosa, and a mildly depapillated dorsal tongue (Figure 5(c)). The ulcers on both sides of the lateral tongue resolved (Figures 5(d) and 5(e)).
case_images: The fourth-visit intraoral examination revealed mild white striae and hyperpigmentation at the (a) right buccal mucosa and (b) left buccal mucosa. (c) Mildly depapillated dorsum of the tongue. Normal mucosa at the (d) right lateral tongue and (e) left lateral tongue.
case_images: CRID2024-1975932.006.jpg
case_images: PMC11192598_01_CRID2024-1975932.006.jpg
case_images: fig6
case_images: Clinical examination revealed a mild white line and postinflammatory hyperpigmentation at the left and right buccal mucosa with a mildly depapillated area at the dorsum of the tongue (Figure 6).
case_images: Timeline of the case from the beginning to the end. OLP = oral liche planus; H&E = hematoxylin and eosin; DIF = direct immunofluorescent; Dx = diagnosis; Tx = treatment.
case_images: CRID2024-1975932.007.jpg
case_images: PMC11192598_01_CRID2024-1975932.007.jpg
case_images: fig7
case_images: To bring closure to the case, it took four visits over a span of two months to effectively address and resolve the illness, as outlined in Figure 7.