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A Dramatic Case of Odynophagia.

B Sopeña1, J Limeres2, L García-Caballero2

  • 1Department of Internal Medicine, Complexo Hospitalario Universitario, University of Santiago de Compostela (USC), Santiago de Compostela, Spain.

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|November 13, 2017
PubMed
Summary

Recurrent necrotizing aphthous stomatitis, a severe form of canker sores, can dramatically impact quality of life. Thalidomide, an immunomodulator, effectively treated a patient

Keywords:
Aphthous stomatitisDeglutitionDeglutition disordersDysphagiaOdynophagiaOral ulcerSutton’s diseaseThalidomide

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Area of Science:

  • Oral Medicine
  • Immunodermatology

Background:

  • Recurrent aphthous stomatitis (RAS) encompasses various clinical presentations.
  • Recurrent necrotizing major aphthous stomatitis, or Sutton's disease, is a severe variant of RAS.

Observation:

  • A 77-year-old male with aortic stenosis and interstitial lung disease presented with severe, painful necrotic oral lesions.
  • Extensive diagnostic workups, including biopsies and specialized staining, yielded inconclusive results.
  • The patient experienced significant morbidity, requiring hospitalization, parenteral nutrition, and psychiatric support.

Findings:

  • Thalidomide administration led to complete remission of the lesions.
  • Lesions recurred upon dose reduction of thalidomide, indicating its efficacy.
  • Scarring sequelae were noted after initial treatment.

Implications:

  • Recurrent necrotizing major aphthous stomatitis can have a severe and debilitating course.
  • The lack of a uniform etiopathogenesis complicates treatment strategies.
  • Immunomodulators like thalidomide represent a potential therapeutic option for severe cases unresponsive to other treatments.