Case History : 1

A 70-year-old male patient presents to the clinic to seek oral help. His chief complaints were burning tongue, red at the tip, white bumps on the rear, cuts on the tongue, lesion, and bad taste. The patient reported difficulty in speaking. Eating spicy food was not a problem. The anterior dorsal tongue was noted for erythaema, and the remaining oral tissues appeared to be within normal limits. The otolaryngologist elucidated that the patient had previously been treated for cutaneous psoriasis. The patient reported that he had had dry red blotchy lesions on the legs, trunk, and face.

Investigation results are as follows:

Negative for periodic acid-Schiff (PAS) testing for candidiasis

Negative food hypersensitivity test

Negative fungal DNA identification culture and sensitivity assay

Histopathology slide showed elongated rete pegs

Which of the following is the most likely diagnosis?

Food hypersensitivity reaction

Oral candidiasis

Lichen planus

Right Answer

Oral psoriasis lesions are often misdiagnosed for other, more common pathologies. A definitive diagnosis can be challenging due to several factors including an unclear etiology, ill-defined clinical and histopathologic criteria, and rare occurrence with a variety of presentations
In this case, the correct diagnosis relies on a careful study of the patient's history, physical exam, and biopsy with histological examination. Most oral psoriasis lesions appear in the context of cutaneous lesions, either presenting simultaneously or appearing in patients with a history of cutaneous psoriasis. Depending on the investigations, it was clear that he had no food hypersensitivity and showed negative culture for candida ruling out diagnosis for oral candidiasis

Wrong Answer

Food sensitivity reaction - People can experience hypersensitive responses to more than one type of food. Some foods can trigger both an allergic reaction and intolerance, e.g. milk, wheat. Processing a food, e.g. cooking may or may not alter its allergenicity. Avoidance is currently the only way of managing a food allergy or intolerance

Wrong Answer

Oral candidiasis - Oral candidiasis, is a condition that occurs when a fungus called Candida albicans builds up on the lining of mouth. Anyone can develop oral thrush, but babies, young children, older adults, or anyone with a compromised immune system due to an illness such as HIV are more susceptible.

Wrong Answer

Lichen planus - It is a chronic inflammatory lesion without a known etiology. Recent studies have indicated the role of vitamin D on immune system and proposed its anti-inflammatory effects.

Ferris WJ, Mikula S, Brown R, Farquharson A. Oral Psoriasis of the Tongue: A Case Report. Cureus. 2019 Dec 7;11(12):e6318. doi: 10.7759/cureus.6318. PMID: 31938609; PMCID: PMC6944151.