Oral mucositis in patients receiving low-dose methotrexate therapy for rheumatoid arthritis: report of 2 cases and literature review.

BACKGROUND: The differential diagnosis of ulcerative oral lesions is diverse. This report discusses the rare causes of oral mucosal ulceration and suggests approaches for diagnosis and treatment. METHODS: Two cases of methotrexate-induced stomatitis in patients receiving low dose methotrexate for rheumatoid arthritis are presented with a review of the current literature. In case 1, mucositis was caused by an unintended methotrexate overdose. In case 2, oral lesions were the result of chronic methotrexate toxicity. The treatment for methotrexate-induced mucositis required hospitalization in case 1, methotrexate discontinuation in both cases and oral folic acid supplementation in case 2. RESULTS: In both cases, the mucositis healed and no relapse was observed. CONCLUSION: Mucositis may be an early sign of systemic conditions, and dental providers are often the first doctors involved in the assessment of oral mucosal diseases. Meticulous questioning of the patient's history and the physical examination is important for elucidating the underlying cause.

[Severe pancytopenia and stomatitis in a patient treated with low-dose methostraxate]. / Schwere Panzytopenie und Stomatitis unter low-dose-Therapie mit Methotrexat.

A 68-year-old female patient presented at the emergency room with episodes of epistaxis, dysphagia and malaise. The patient had acute prerenal renal failure, probably in association with previous infection of the airways and treatment with NSAID's. Laboratory values revealed greatly decreased leukocyte and platelet counts as well as anemia. The patient had a diagnosis of a seronegative arthritis since 9 months and, therefore, was treated with low dose methotrexate (MTX) 10 mg/week. After exclusion of other causes, myelosupression was considered to be associated with low-dose MTX. After stopping MTX and treatment with folic acid leucocyte and platelet counts returned to normal and stomatitis recovered as well within nine days. We discuss the pharmacology of low-dose MTX and in particular the risk factors and prophylaxis of its toxicity. Renal function needs special attention in patients treated with low-dose MTX.

Attenuation of radiation- and chemoradiation-induced mucositis using gamma-D-glutamyl-L-tryptophan (SCV-07).

OBJECTIVE: To evaluate the efficacy of a novel immunomodulating peptide (SCV-07) in attenuating the course of radiation-induced mucositis in an established animal model of oral mucositis (OM). MATERIAL AND METHODS: In three separate experiments, golden Syrian hamsters received either an acute radiation challenge to the buccal mucosa of eight fractionated doses of 7.5 Gy of radiation over a 2-week-period, or a combination of acute radiation and cisplatin. In each experiment, animals were treated with varying doses or schedules of SCV-07 or placebo. OM was scored in a blinded fashion using digital images obtained during the experimental period. RESULTS: We found that SCV-07 reduced the severity and duration of both acute and fractionated radiation-induced OM. Similarly, when radiation and chemotherapy were used to induce OM, treatment with SCV-07 significantly reduced the duration of ulcerative OM. The therapeutic benefit was dependent on both dose and schedule of administration. CONCLUSION: Taken together, we found SCV-07 was able to modify the duration and severity of oral mucositis and was dependent on schedule and dose.

Validation of the oral mucositis assessment scale in pediatric cancer.

BACKGROUND: Our objective was to examine the construct validity of the Oral Mucositis Assessment Scale (OMAS) in children receiving doxorubicin chemotherapy. METHODS: Children between 6 and 18 years of age with cancer receiving doxorubicin-containing chemotherapy were included. OMAS was measured on days 7, 10, 14, and 17 after chemotherapy. Other measures of mucositis obtained concurrent with OMAS were the World Health Organization (WHO) mucositis scale and pain visual analogue scale (VAS). We also recorded analgesia administration. RESULTS: Sixteen children were studied for 45 post-chemotherapy cycles and 156 OMAS assessments were performed. OMAS was moderately correlated with WHO scores (r = 0.56; P = 0.0006) whereas correlation with the pain VAS was fair (r = 0.37; P = 0.002). OMAS also had fair correlation with the number of doses of topical analgesia (r = 0.43; P = 0.001) and with the cumulative dose of opioid analgesia (r = 0.38; P = 0.003). CONCLUSIONS: The OMAS is valid for use in mucositis clinical trials for children at least 6 years of age.

Ecstasy related periodontitis and mucosal ulceration -- a case report.

Methylenedioxymethamphetamine (MDMA) more commonly known as 'Ecstasy' is a widely used recreational drug. The oral and systemic effects associated with its use have been well documented. This paper highlights a previously unreported complication of MDMA use on the oral mucosa. MDMA periodontitis is illustrated with a case report and the local oral and systemic effects of MDMA use outlined.

Oral manifestations of agranulocytosis associated with methimazole therapy.

This paper reports a case of agranulocytosis that developed in a patient with hyperthyroidism two months after the administration of methimazole. The patient manifested symptoms of fever, sore throat, profound leukopenia, and oral complications such as generalized gingival necrosis and mucosa ulceration, which subsequently abated upon withdrawal of the drug. Dental practitioners should be aware of the potential of agranulocytosis associated with methimazole therapy. The oral manifestations should be kept in mind.

Painful oral mucosal ulcers in a patient with small cell carcinoma of the lung.

This case illustrates the development of multiple painful oral ulcers caused by methotrexate that was one of a combination of chemotherapeutic drugs administered for the treatment of small cell carcinoma of the lung. Although the oral mucositis is self-limiting and resolves when the drug dose is reduced or therapy is discontinued, severe pain and discomfort may cause physical debilitation. Moreover, the risk of secondary oral infections is high in patients undergoing such therapy, and if the appropriate treatment is not instituted, fatal systemic dissemination of the infection may occur.

Relationship of oral complications to peripheral blood leukocyte and platelet counts in patients receiving cancer chemotherapy.

Patients undergoing cancer chemotherapy often suffer from oral complications as a result of their disease and its treatment. The effects of the chemotherapy on the bone marrow and oral mucosa, coupled with the patient's immunosuppressed state and altered oral microbial flora, predispose these patients to oral mucositis, infection, and hemorrhage. The oral mucosa appears to mirror the effects of the chemotherapy on the bone marrow, as there appears to be a direct relationship between the changing peripheral blood counts and the status of the oral mucosa.

[Effect of Prednimustine (Leo 1031) in chronic lymphatic leukemia]. / Die Wirkung von Prednimustine ("LEO 1031") bei chronischen lymphatischen Leukämien

46 ambulatory patients with chronic lymphocytic leukemia were treated with Prednimustine either continuously (daily or each other day 20 mg) or intermittently (daily 20 mg for 14 days, followed by a pause of 4 weeks). A good response was seen in 28 patients lasting up to 17 + months (mean 4,5 + months) after terminating therapy. Patients without prior chemotherapy have improved earlier and to a smaller amount of the total dose applicated. Signes of bone marrow toxicity (anaemia, thrombocytopenia) were observed in 8 cases, gastrointestinal side effects in 7 cases, cutaneous exanthema in 3 cases, and one patient exhibited a severe stomatitis after treatment. Prednimustine constitutes an effective drug for chronic lymphatic leukemia.

Contact dermatitis from propolis.

Two patients with contact dermatitis due to the natural product propolis (bee glue) are reported. They presented perioral eczema and stomatitis which were recalcitrant until propolis was considered as the cause. Patch tests with propolis preparations were positive in both patients, and, furthermore, in the second patient the lesions relapsed after provocation tests. European standard patch test including balsam of Peru were negative. The complexity of propolis, its supposed anti-inflammatory effect due to flavonoids, and the sensitizing agents originating mainly from the poplar trees are discussed together with the cross-sensitization to balsam of Peru. Contact dermatitis due to propolis should be considered in unexplained eczemas, mainly perioral but also in other areas, as propolis preparations are available also as ointments and cosmetic creams.