Severe uremic stomatitis in a patient with untreated chronic renal failure

¹University of Monastir, Dental Faculty of Monastir, Research Laboratory LR12ES11, Monastir, Tunisia

^&Corresponding author
Dorsaf Touil, University of Monastir, Dental Faculty of Monastir, Research Laboratory LR12ES11, Monastir, Tunisia

Image in medicine    

A 36-year-old female patient with chronic renal failure was referred by the internal medicine department for severe and painful oral lesions extending to the nasal mucosa. The patient's medical record revealed that she did not receive dialysis during the last 2 months. Oral examination revealed white hyperkeratotic lesions of the tongue together with a diffuse erythema covered with thick whitish-yellow pseudo membrane. An ulcerated painful lesion of 3 cm in size was present in the hard palate. Similar lesions were present in the nostrils, especially on the right side. Painful plaques and crusts were also present in both lips. The patient reported severe burning sensation, xerostomia, and halitosis. She was also suffering from loss of appetite, nausea, and dysphagia. Severe weight loss was also noted. Laboratory tests revealed elevated serum creatinine: 711umol/l (normal 40-115umol), uremia: 32.8mmol/l (normal 2.8-7.2mmol/l), and uric acid 889umol/l (normal 180-420 umol). Protein C reactive was also elevated with 42mg/l (normal <8mg/l). Treatment consisted in improving urea blood concentration and the underlying renal failure. The patient was also asked to improve her oral hygiene using antiseptic mouthwashes (chlorhexidine digluconate 0.12%) and antifungal agents (fungizone).

Figure 1: A) multiple ulcerated painful lesions of the hard palate, the nostrils and the lips; B) white hyperkeratotic lesions of the tongue associated to diffuse erythema covered with whitish-yellow membrane