WHO STABBED THE DRAGON? A Rare case of Burning Mouth Syndrome.
A 76 y/o female presented to the ER with Stab wound in the palate. On interview the relatives told that she was unable to eat or drink anything for the past 2 months and had lost twenty kgs since then and has consulted various doctors who were unable to come up with a diagnosis. To rule out Homicidal intent Police investigation was called and it turned out the Patient had tried to commit suicide by stabbing herself repeatedly, since she felt a persistent burning sensation in her mouth. She later confessed that she wanted to die from bleeding because she could not eat and she felt helpless. She preferred to die quickly using a knife instead of dying of thirst and hunger.
There were multiple Stab wounds to the palate and the patient was anemic. On admission to the Hospital a psychiatric evaluation following her recovery revealed depressed mood most of the day, marked diminished interest or pleasure in all or almost all activities, insomnia, and fatigue with diminished ability to think or concentrate. She scored 24 on Beck Depression Inventory and 22 in MMSE with No delusions.
Regarding somatoform disorders, pain in the oral cavity started the last three months, only in this specific anatomic area, and the patient had no gastrointestinal or pseudoneurological symptoms.
This is a Rare Patient of Burning Mouth Syndrome who was treated with 40 mg Paroxetine for 3 months. The patient scored 12 on Beck Depression Inventory and had no suicidal ideations on Follow up.