Oral Manifestations of Systemic Lupus Erythematous and Its Comprehensive Management: Two Case Reports

Rita Wardhani, Irna Sufiawati

Abstract


Systemic lupus erythematous (SLE) is an autoimmune collagen-vascular disease involving mucocutaneous and musculoskeletal systems as well as blood vessels that is characterized by diverse clinical manifestations, making it necessary to use a comprehensive multidisciplinary approach. Oral manifestations of SLE include oral ulcer, discoid lesions, oral lichen planus-like-lesion, oral candidiasis, and xerostomia. This study reports two cases of 19-year-old and 41-year-old female patients visiting the Oral Medicine Department Dr. Hasan Sadikin General Hospital in October 2016. These patients were referred by the Internal Medicine Department with SLE diagnosis, involving hematological, musculoskeletal and mucocutaneous systems. Extraoral examination revealed moon face in the first patient and malar rash and lips exfoliations in the second  patient. Intraoral examination revealed oral ulcers on buccal and labial mucosa as well palate in both patients. Both patients were given methyl prednisolone, calcium, and folic acid by the Internal Medicine Department. Oral ulcers were treated with prednisone mouthwash, nystatin oral suspension, and vitamin B12. The oral ulcer on palate was considered very difficult to resolve so that topical corticosteroid was required. Prednisone mouthwash was chosen as drug of choice due to its efficacy on oral mucosa and its ability to minimize the systemic adverse effects which were resolved in 6 week after starting treatment. Comprehensive multidisciplinary approach associated with oral manifestation of SLE has significant effects in decreasing disease severity and improving the quality of life in patients with SLE.

Key words: Oral ulcers, prednisone mouthwash, systemic lupus erythematosus

 

Manifestasi Oral Lupus Eritematosus Sistemik dan Manajemen Komprehensifnya: Dua Laporan Kasus

Sistemik lupus eritematosus (SLE) adalah penyakit kolagen-vaskular autoimun, yang melibatkan sistem mukokutan, muskuloskeletal, dan pembuluh darah yang ditandai dengan manifestasi klinis yang bervariasi, sehingga diperlukan pendekatan multidisiplin yang komprehensif. Manifestasi oral SLE meliputi ulkus mulut lesi diskoid, lichen planus-like lesion, kandidiasis oral, dan serostomia. Pasien wanita berusia 19 tahun dan 41 tahun yang dirujuk dari departemen Penyakit Dalam pada Oktober 2016 dengan diagnosis SLE yang melibatkan hematologis, muskuloskeletal, dan mukokutan. Pemeriksaan ekstraoral menunjukkan moon face pada pasien pertama, dan malar rash serta pengelupasan bibir pada pasien kedua. Pemeriksaan intra oral mengungkapkan ulkus oral, mukosa labial, dan palatum pada kedua pasien. Kedua pasien diberikan metil prednisolone, kalsium, dan asam folat dari departemen Penyakit Dalam. Ulkus oral diobati dengan obat kumur prednison, suspensi oral Nistatin, dan vitamin B12 yang diberikan dalam 6 minggu pengobatan. Ulkus oral adalah salah satu manifestasi oral yang umum pada pasien SLE. Ulkus oral pada palatum dianggap sangat sulit diatasi sehingga dibutuhkan kortikosteroid topikal. Prednisone mouth wash dipilih sebagai obat pilihan sebagai anti-inflamasi pada mukosa oral dan meminimalkan efek samping sistemik. Pendekatan multidisiplin komprehensif yang terkait dengan manifestasi oral SLE memiliki efek signifikan dalam menurunkan tingkat keparahan penyakit dan meningkatkan kualitas hidup pada pasien SLE.

Kata kunci: Lupus eritematosus sistemik, ulser oral, obat kumur prednison


Keywords


Oral ulcers; prednisone mouthwash; systemic lupus erythematosus

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References


Bertsias G, Carvera R, Boumpas TD. Systemic Lupus Erythematosus: Pathogenesis and Clinical Features. In: Bijlsma JWJ, editor. EULAR Textbook on Rheumatic Diseases. 1st Edition. London: BMJ Group; 2012. p. 476–505.

Danza A, Ruiz-Irastorza G. Infection risk in systemic lupus erythematosus patients: susceptibility factors and preventive strategies. Lupus. 2013;22(12):1286–94.

Nico MM, Vilela MA, Rivitti EA, Lourenco SV. Oral lesions in lupus erythematosus: Correlation with cutaneous lesions. Eur J Dermatol. 2008;18(4):376–81.

Crispín JC, Liossis SN, Kis-toth K, Lieberman LA, Kyttaris VC, Juang Y, Tsokos GC. Pathogenesis of human systemic lupus erythematosus : recent advances. Trends Mol Med. 2010;16(2):47–57.

Handa R. Management of Systemic Lupus Erythematosus. In: Rao MS, Editor. Medicine Update. Volume 20. Mumbai: APIIndia; 2010. p. 839–44.

Hahn BH, McMahon MA, Wilkinson A, Wallace WD, Daikh DI, Fitzgerald JD, et al. American college of rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Care Res (Hoboken). 2012;64(6):797–808.

de Araújo ALPK, Paliares IC, de Araújo MIPK, Novo NF, Cadaval RAM, Martinez JE. The association of fibromyalgia and systemic lupus erythematosus change the presentation and severity of both diseases? Rev Bras Reumatol. 2015;55(1):37–42.

Chiewchengchol D, Murphy R, Edwards SW, Beresford MW. Mucocutaneous manifestations in juvenile-onset systemic lupus erythematosus: a review of literature. Pediatr Rheumatol Online J. 2015;13(1):1–9.

Pisetsky DS. Systemic Lupus Erythematosus B. Epidemiology, Pathology, and Pathogenesis. In: Klippel JH, Stone JH, Crofford LJ, White PH, editors. Primer on the Rheumatic Diseases. 13th Edition. New York: Springer; 2008. p. 319–27.

Zampeli E, Klinman DM, Gershwin ME, Moutsopoulos HM. A comprehensive evaluation for the treatment of lupus nephritis. J Autoimmun. 2017;78(1):1–10.

Shankar S, Behera V. Advances in management of systemic lupus erythematosus. Symp Rheumatol. 2014;19(1):28–36.

van Vollenhoven RF, Mosca M, Bertsias G, Isenberg D, Kuhn A, Lerstrøm K, et al. Treat-to-target in systemic lupus erythematosus : recommendations from an international task force. Ann Rheum Dis. 2014;73(6):958–67.

Rahman A, Isenberg DA. Systemic lupus erythematosus. N Engl J Med. 2008;358(9):929–39.

Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrisson’s Principle of Internal Medicine. 18th Edition. USA: McGrawHill; 2012.

Sestak AL, Fürnrohr BG, Harley JB, Merrill JT, Namjou B. The genetics of systemic lupus erythematosus andimplications for targeted therapy. Ann Rheum Dis. 2011;70(1):i37–43.

Bosch X. Systemic lupus erythematosusand the neutrophil. N Engl J Med. 2011;365(8):758–60.

Roy JS, Das PP, Datta A. SLE in Pregnancy. BSMMU J. 2010;3(1):54–9.

Sanchez E, Nadig A, Richardson BC, Freedman BI, Kaufman KM, Kelly JA, et al. Phenotypic associations of genetic susceptibility loci in systemic lupus erythematosus. Ann Rheum Dis. 2011;70(10):1752–7.

Blank M, Shoenfeld Y, Perl A. Cross-talk of the environment with the host genome and the immune system through endogenous retroviruses insystemic lupus erythematosus. Lupus. 2009;18(13):1136–43.

Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012;64(8):2677–86.




DOI: http://dx.doi.org/10.15395/mkb.v50n1.1234

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