Management of Patients with Oral Lesions Associated Systemic Lupus Erythematous (SLE) Nephritis: A Case Report
Abstract
Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease involving multi-organ such as mucocutaneous, musculoskeletal, and blood vessels with varied extraoral and intraoral clinical manifestations that require treatment from many medical specialists including dentists. The purpose of writing a case report is to describe how to manage oral lesions in patients with SLE Nephritis.
Case report: A female 17 years old patient was referred to the oral medicine department of Dr. Hasan Sadikin General Hospital from the pediatrics department and was diagnosed with SLE nephritis due to complaints of ulcers on almost the entire oral mucosa. Extraoral examination revealed a moon face, malar rash, and erythematous rash on the palms of the hands. Intraoral examination revealed multiple ulcers, on labial mucosa, buccal mucosa, lateral right of the tongue, palate, and white plaque on the dorsum of the tongue. The therapy provided was non-pharmacological and pharmacological. Non-pharmacological therapies include oral hygiene instruction and communication, information, education. Pharmacological therapy is a solution containing sucralfate and prednisone which is gargled for one minute, then followed by nystatin oral suspension drug that discards after one minute, then followed by chlorhexidine digluconate 0,12% mouthwash, gargle for one minute, as an antiseptic (each drug is applied in 0,5 – 1 hours). The patient has received a systemic corticosteroid drug (methylprednisolone), but the treatment of oral lesions requires additional topical corticosteroids to accelerate the healing process because of its direct effect on the mucosa.
Conclusion: The management of oral lesions using topical corticosteroids in patients with SLE nephritis can help accelerate the healing process.
Keywords: Management, Oral Lesions, SLE nephritis
Keywords:
Management, Oral Lesions, SLE nephritisDOI
https://doi.org/10.22270/jddt.v14i2.6275References
Hammoudeh M, Al-Momani A, Sarakbi H, Chandra P, Hammoudeh S. Oral Manifestations of Systemic Lupus Erythematosus Patients in Qatar: A Pilot Study. Int J Rheumatol. 2018;2018. https://doi.org/10.26226/morressier.5a83dfbed462b8029238bb43
Wesley S. Oral Manifestations of Systemic Lupus Erythematosus : A Case Report. Int J Dent Clin. 2014;6(2):35-6.
Windi RR, Graharti R. Overload Cairan pada Anak dengan Nephritis Lupus Fluid Overload in Children With NephritisLupus. 2018;2:181-7.
Fortuna G, Brennan MT. Systemic lupus erythematosus. Epidemiology, pathophysiology, manifestations, and management. Dent Clin North Am. 2013;57(4):631-55. https://doi.org/10.1016/j.cden.2013.06.003 PMid:24034070
Ben-Menachem E. Systemic lupus erythematosus: A review for anesthesiologists. Anesth Analg. 2010;111(3):665-76. https://doi.org/10.1213/ANE.0b013e3181e8138e PMid:20601448
Kuhn A, Bonsmann G, Anders H, Tenbrock K, Schneider M. The Diagnosis and treatment of systemic lupus erythematosus. Dtsch Aerzteblatt online. 2015;112(25):423-32. https://doi.org/10.3238/arztebl.2015.0423 PMid:26179016 PMCid:PMC4558874
Barbhaiya M, Costenbader K. Environmental Exposures and The Development of Systemic Lupus Erythematosus. Curr Opin rheumatol. 2016;28(5):497-505. https://doi.org/10.1097/BOR.0000000000000318 PMid:27428889 PMCid:PMC4965307
Mackern-Oberti JP, Llanos C, Riedel CA, Bueno SM, Kalergis AM. Contribution of dendritic cells to the autoimmune pathology of systemic lupus erythematosus. Immunology. 2015;146(4):497-507. https://doi.org/10.1111/imm.12504 PMid:26173489 PMCid:PMC4693898
Khatibi M, Shakoorpour AH, Jahromi ZM, Ahmadzadeh A. The prevalence of oral mucosal lesions and related factors in 188 patients with systemic lupus erythematosus. Lupus. 2012;21(12):1312-5. https://doi.org/10.1177/0961203312454589 PMid:22833437
Chi AC, Neville BW, Krayer JW, Gonsalves WC. Oral manifestations of systemic disease. Am Fam Physician. 2010;82(11):1381-8.
Costenbader KH, Feskanich D, Stampfer MJ, Karlson EW. Reproductive and menopausal factors and risk of systemic lupus erythematosus in women. Arthritis Rheum. 2007;56(4):1251-62. https://doi.org/10.1002/art.22510 PMid:17393454
Khwaja T, Tayaar S. Review of oral ulcers: A diagnostic dilemma. J Med Radiol Pathol Surg [Internet]. 2016;3:20-4. https://doi.org/10.15713/ins.jmrps.70
N AD. Respon Imun pada Infeksi Jamur. J Kedokt dan Kesehat Indones [Internet]. 2014;6(2):55-66. Available from: https://www.researchgate.net/publication/299386180_RESPON_IMUN_PADA_INFEKSI_JAMUR https://doi.org/10.20885/JKKI.Vol6.Iss2.Art2
DE SOUZA IF, DE SOUZA TT, CURTY ÁA, LEAL LF, PESSÔA TM, PICCIANI BLS, et al. Pp - Oral Manifestations of Systemic Lupus Erythematosus: a Case Report. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;123(2):e79. https://doi.org/10.1016/j.oooo.2016.09.205
Zampeli E, Klinman DM, Gershwin ME, Moutsopoulos HM. A comprehensive evaluation for the treatment of lupus nephritis. J Autoimmun [Internet]. 2017;78:1-10. https://doi.org/10.1016/j.jaut.2016.12.011 PMid:28082046
Rosenbaum JT, Lim LL, Sibley CH. Ocular, aural, and oral manifestations of lupus. Ninth Edit. Dubois' Lupus Erythematosus and Related Syndromes. Elsevier Inc.; 2018. 556-565 p. https://doi.org/10.1016/B978-0-323-47927-1.00044-X
Uva L, Miguel D, Pinheiro C, Freitas JP, Marques Gomes M, Filipe P. Cutaneous manifestations of systemic lupus erythematosus. Autoimmune Dis. 2012;1(1). https://doi.org/10.1155/2012/834291 PMid:22888407 PMCid:PMC3410306
Nico MMS, Bologna SB, Lourenço S V. The lip in lupus erythematosus. Clin Exp Dermatol. 2014;39(5):563-9. https://doi.org/10.1111/ced.12368 PMid:24934909
Mühlhauser M, Rivas LM. Strongyloides stercoralis. Rev Chil Infectol. 2013;30(5):513-4. https://doi.org/10.4067/S0716-10182013000500008 PMid:24248166
Sulochana SP, Syed M, Chandrasekar D V., Mullangi R, Srinivas NR. Clinical Drug-Drug Pharmacokinetic Interaction Potential of Sucralfate with Other Drugs: Review and Perspectives. Eur J Drug Metab Pharmacokinet. 2016;41(5):469-503. https://doi.org/10.1007/s13318-016-0335-4 PMid:27086359
Simon R Bramhall MMMO. Is there still a role for sucralfate in the treatment of gastritis? Simon. World J Meta-Anal 2020 Febr 28; 8(1) 1-3 https://doi.org/10.13105/wjma.v8.i1.1
Etiz D, Erkal HŞ, Serin M, Küçük B, Hepari A, Elhan AH, et al. Clinical and histopathological evaluation of sucralfate in the prevention of oral mucositis induced by radiation therapy in patients with head and neck malignancies. Oral Oncol. 2000;36(1):116-20. https://doi.org/10.1016/S1368-8375(99)00075-5 PMid:10889930
RATTAN J, SCHNEIDER M, ARBER N, GORSKY M, DAYAN D. Sucralfate suspension as a treatment of recurrent aphthous stomatitis. J Intern Med. 1994;236(3):341-3. https://doi.org/10.1111/j.1365-2796.1994.tb00805.x PMid:8077892
Sajjan P, Laxminarayan N, Kar PP SM. Chlorhexidine as an Antimicrobial Agent in Dentistry - A Review. Oral Health Dent Manag. 2016;15(2):93-100.
Munthe EKM, Sufiawati I. Oral lesions as a clinical sign of systemic lupus erythematosus. 2018;51(32):147-52. https://doi.org/10.20473/j.djmkg.v51.i3.p147-152
Wardhani R, Sufiawati I. Oral Manifestations of Systemic Lupus Erythematous and Its Comprehensive Management: Two Case Reports. Maj Kedokt Bandung. 2018;50(1):61-6. https://doi.org/10.15395/mkb.v50n1.1234
Tamigoes Y, Dewi TS. Terapi lesi oral pasien sindrom Stevens-Johnson disertai lupus erythematosus sistemik, Oral lesion therapy in patients with Stevens-Johnson syndrome with systemic lupus erythematosus. J Kedokt Gigi Univ Padjadjaran. 2018;30(3):181. https://doi.org/10.24198/jkg.v30i3.17978
Published



How to Cite
Issue
Section
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).