Manuscript:
A 50-year-old woman was referred to the department of dentistry complaining of xerostomia and mouth burning on her tongue. The patient suffered from anorexia and dysphagia. The patient’s medical history included chronic renal failure in the hemodialysis stage. She started hemodialysis 2 months ago with one session per week.
Extraoral examination showed ulcerative, hemorrhagic and crusting lesions localized on the nostril rim, philtrum and superior lip (Figure 1). Intraoral examination revealed the presence of multiple hemorrhagic ulcerations involving the dorsal surface of the tongue, buccal mucosa and mucous surfaces of the lips. Lesions were covered by an adherent thick white-yellowish membrane (Figure 2).
Laboratory studies showed a creatine level of 711 µmol/L and a blood urea nitrogen level of more than 32 mmol/L. A diagnosis of hemorrhagic ulcerative uremic stomatitis was made. Hemodialysis sessions were doubled and partially resolution of oral mucosal lesions was seen after 10 days.
Uremic stomatitis is a rare manifestation associated with longstanding uremia in chronic renal failure patients [1]. Its evolution is favorable with earlier institution of renal replacement therapy [2]. This case shows that this condition should always be suspected by the dentist when the context of advanced renal disease is present.
[1] Barie E. De la stomatite uremique. Arch Gen Med 1889;2:415-32.
[2] Liao C-Y, Wu C-C, Chu P-L. Uremic stomatitis. QJM 2017;110:247–8.