Oral mucosal lesions in a COVID-19 patient: New signs or secondary manifestations?

Abstract

Some oral manifestations have been observed in patients with coronavirus disease 2019 (COVID-19). However, there is still a question about whether these lesions are due to coronavirus infection or secondary manifestations resulting from the patient's systemic condition. Thus, this article aims to report an additional case of an oral condition in a patient diagnosed with COVID-19. Our patient, a sixty-seven-year-old Caucasian man, tested positive to coronavirus and presented oral manifestations such as recurrent herpes simplex, candidiasis, and geographic tongue. We support the argument that some oral conditions could be secondary to the deterioration of systemic health or due to treatments for COVID-19. The present case report highlights the importance of including dentists in the intensive care unit multi-professional team to improve oral health in critical patients, not only COVID-19 patients, but also, to contribute to evidence-based and decision-making in managing infectious diseases.

Keywords: COVID-19; Candidiasis; Case report; Geographic tongue; Oral conditions; Recurrent herpes simplex; SARS-CoV-2.

Figure 1

(A) April 24, 2020. COVID-19 patient presenting a white plaque on the tongue dorsum, centrally located, associated with several small, circle-shaped yellowish ulcers resembling the late stage of herpetic recurrent oral lesions associated with candidiasis. A nodule located in the lower lip was observed, measuring approximately 1 cm in its largest diameter, suggesting a reactive lesion (fibroma). (B) May 7, 2020. COVID-19 patient presenting atrophic areas surrounded by an elevated yellow-white halo classified as severe geographic tongue according to the severity index scoring system (Picciani et al., 2019) associated with fissured tongue. Also, the tongue’s white lesions, suggestive of candidiasis, showed almost complete resolution. (C) May 25, 2020. The patient, recovered from COVID-19, showing atrophic areas surrounded by an elevated yellow-white halo classified as moderate geographic tongue according to the severity index scoring system (Picciani et al., 2020). We could observe a slightly erythematous area in the right palatine tonsil region; however, the patient reported being asymptomatic.