Chemotherapy-induced mucositis - Oral Mucosal Lesion
While not all chemotherapeutic agents will cause mucositis, many have this capability. The degree to which mucositis is induced is also dependent on the drug and the age of the patient, with younger patients often experiencing more severe signs and symptoms. Patients complain of pain and burning that is exacerbated by eating and oral hygiene procedures.
K12.31 – Oral mucositis (ulcerative) due to antineoplastic therapy
403666006 – Drug-induced mucositis
- Herpes simplex virus (HSV) infection – An immunosuppressed state can result in reactivation of herpes virus, and these lesions often appear atypical in such patients. Clustered, coalescent ulcers on either the keratinized or nonkeratinized mucosa are suggestive, and cultures should be performed.
- Acute graft-versus-host disease – This would develop only in patients who have received an allogeneic hematopoietic cell transplant. Involvement of the tongue dorsum and hard palate mucosa, or sudden exacerbation of oral ulcers after engraftment, should raise suspicions for this condition.
- mTOR-inhibitor-associated oral ulcers – These are aphthous-like ulcers that occur 1-2 weeks after the start of mTOR inhibitors.
- Pemphigus vulgaris – This condition is usually chronic and often affects the oral mucosa initially. Lesions are not associated with chemotherapy.
- Paraneoplastic pemphigus – This uncommon condition develops in patients who have a history of hematologic malignancy, and oral ulcers are present in all cases. Often the polymorphous nature of the lesions, which can resemble lichen planus, pemphigoid, erythema multiforme, and/or pemphigus vulgaris, will suggest this diagnosis.
- Erythema multiforme – This condition represents a hypersensitivity reaction, usually to reactivated or recrudescent HSV. Some patients may have only oral involvement, but a significant percentage will develop skin lesions also. The diagnosis can be made on the basis of characteristic "target" or "iris" lesions on the skin.
- Ulcerative lichen planus – This condition is usually chronic and is characterized by symmetrical involvement of the oral mucosa. The ulcerations are surrounded by radiating white striae.
- Mucous membrane pemphigoid – This condition is typically chronic and primarily involves the attached gingivae, unlike chemotherapy-induced mucositis. A biopsy with direct immunofluorescence studies confirms the diagnosis.