Oral lesions in patients with SARS-CoV-2 infection: could th
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Several viruses transmitted through saliva, such as herpes simplex virus, cytomegalovirus, and Zika virus, are capable of infecting and replicating in the oral mucosa, leading to painful oral ulcers. Few studies have described the oral manifestations of coronavirus disease 2019 (COVID-19). There is growing evidence that angiotensin-converting enzyme 2 (ACE2), the main host cell receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is highly expressed on the epithelial cells of the tongue and of the salivary glands, which may explain the development of dysgeusia in patients with COVID-19. Hence, it is important to understand if SARS-CoV-2 can infect and replicate in oral keratinocytes and fibroblasts, causing oral ulcerations and superficial necrosis.

An 81-year-old man with a cough and progressive chest tightness present for 10 days was admitted to the Hospital. The patient had a history of well-controlled hypertension and chronic obstructive pulmonary disease. Fifteen days earlier, he had come in contact with a family member who had traveled to Israel and had been recently diagnosed with SARS-CoV-2 pneumonia. Five days later, the patient developed chills and fever, and a maximum body temperature of 37.7°C. The patient developed a dry cough and mild dyspnea. Physical examination revealed normal body temperature (36°C); blood pressure 108/67 mm Hg; heart rate 83 beats per minute; respiratory rate 25 breaths per minute; and oxygen saturation of 97%. He was conscious and had no dyspnea at the time of hospitalization. Biochemical examination showed that leukocytes and the neutrophils/lymphocytes ratio were all in the normal range (420/mm3); the C-reactive protein level was 23.4 mg/L; and the glucose level was 97 mg/L. The diagnosis of COVID-19 infection was based on real-time reverse transcriptase polymerase chain reaction (rRT-PCR) amplification of the viral DNA from a pharyngeal sample. Computed tomography (CT) revealed multiple “ground glass” images in both lungs.

The patient was placed in a special isolation ward and was treated with azithromycin and ceftriaxone for 7 days. Head and neck examination did not identify asymmetries, swellings, or enlarged cervical lymph nodes. Oral examination revealed multiple shallow aphthous-like ulcers of varying sizes and irregular margins covered with mucopurulent membrane, suggesting superficial necrosis in the upper and lower lip mucosa as well as the anterior dorsal tongue. The lesions were painful on palpation and believed to have developed in the last few days at the time of hospital admission. Herpes simplex virus (HSV-1) was detected in the saliva sample by performing PCR, and the patient was immediately started on intravenous acyclovir 250 mg/m2 3 times a day for 10 days. There was no clinical improvement. As an adjuvant measure to manage the pain associated with the oral ulcers, a trained dentist administered daily photobiomodulation therapy (PBMT) for 10 consecutive days. The PBMT device was positioned perpendicular to the surface of the oral ulcers, for 10 seconds per site, operating at 660 nm wavelength, 40 mW average power, 0.04 cm2 beam area, 1 W/cm2 irradiance, 0.4 J energy, and 10 J/cm2 fluence. This is protocol of PBMT used for patients with oral mucositis associated with cancer therapy. The patient reported symptom relief after 2 days of PBMT, and the oral lesions completely resolved after 11 days of PBMT. After 16 days in the intensive care unit (ICU) and 14 additional days in a critical care unit, the patient's clinical course and respiratory status showed improvement. He was discharged and is currently recovering well at home.

Source: https://www.oooojournal.net/article/S2212-4403(20)31119-6/fulltext?rss=yes
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