- Email: [email protected]
SCLEROTHERAPY OF A LOWER LIP VASCULAR MALFORMATION: CASE REPORT
ABSTRACTS
e90
PARACOCCIDIOIDOMYCOSIS OF THE CHEEK: CASE REPORT. AMANDA FEITOZA DA SILVA, JOHN LENNON SILVA CUNHA, ALLAN ULISSES DE CARVALHO MELO, ENRIK BARBOSA DE ALMEIDA, CLAUBERTO RODRIGUES DE OLIVEIRA, JULIANA CAMPOS PINHEIRO and, RICARDO LUIZ CAVALCANTI DE ALBUQUERQUE JUNIOR Paracoccidioidomycosis (PCM) is a disease caused by the fungus Paracoccidioides brasiliensis, which is common in Brazil and some other areas in Latin America. We report a case of a 50-yearold male patient, a farm worker and smoker, presenting an asymptomatic ulcerated lesion with moriform appearance in the left buccal mucosa and uncertain time of evolution. The presumptive diagnosis was PCM. The patient underwent incisional biopsy, and histopathologic analysis revealed pseudoepitheliomatous hyperplasia and granulomatous inflammatory reaction. Ovoid yeasts with birefringent membrane were also evidenced. Grocott-stained slices demonstrated the presence of microorganisms exhibiting multiple buddings (ships wheel appearances) and double buddings (Mickey Mouse ears). The diagnosis was PCM. The patient was referred to the infectious diseases specialist for treatment of the lesion. Although PCM affects lungs primarily, it is often diagnosed through oral manifestation. Thus, dentists play a fundamental role in the identification of these lesions and referral for appropriate treatment.
ORAL MANIFESTATIONS OF CROHN DISEASE: A CASE REPORT. KAREN LOUREIRO WEIGERT, MARTA BRENNER MACHADO, EDELA PURICELLI, MILTON CRISTIAN COUGO, JESSICA MUNARETTO and, GILBERTO VAUTHIER Crohn disease is an inflammatory chronic, relapsing, immune-mediated disorder of the gastrointestinal tract. Any part of the tract may be involved. We describe a case of a 45-year-old man with Crohn disease and hepatitis C virus genotype 1 a. Previous treatments kept him stable for 21 years. In December 2017, he developed mandibular vestibule ulcers, mucogingivitis, and cobblestones on the buccal mucosa. The patient took prednisolone 20 mg and infliximab, and biopsy of the buccal lesions revealed lymphoplasmacytic infiltration. He went through 4 photodynamic therapy sessions and 10 laser therapy sessions. He had short remission; however, 3 months later new linear ulcers, swelling, pain, and perianal lesions appeared. Microbiologic analysis taken from the oral mucosa did not reveal positive cultures. After these findings, drug treatment was changed, and the patient is currently in the first dose of ustekinumab, 40 mg of prednisone (Meticorten), laser therapy, and topical administration of clobetasol, already showing reduction of manifestations.
GINGIVAL CARCINOMA CUNICULATUM: RARE VARIANT OF SQUAMOUS CELL CARCINOMA OFTEN MISDIAGNOSED AS AN INFLAMMATORY PROCESS. RODRIGO NEVES-SILVA, ALEXANDRE ELIAS TRIVELLATO, CASSIO EDVARD SVERZUT, CARLA BENTO NELEM COLTURATO, LUCIANA YAMAMOTO ALMEIDA, KELLY FERNANDA MOLENA and, JORGE ESQUICHE LEON Carcinoma cuniculatum (CC) is a rare variant of oral squamous cell carcinoma (OSCC). To date, 50 cases of oral CC have
OOOO January 2020 been reported. A 67-year-old white female patient presented complaining of a painless tumor mass in the left mandibular body with several months of evolution. Previous dental history indicated extraction of teeth #37 and #38 and chronic osteomyelitis. Intraoral examination revealed an irregular exophytic mass in the region of the extracted teeth, which exhibited a yellow purulent discharge during palpation. Radiograph evidenced an osteolytic lesion with irregular and ill-defined borders. An incisional biopsy was performed, which showed an intense squamous epithelial proliferation, with frequent invaginations that delimited pseudocystic cavities filled with parakeratin and peeled cells. In the deepest part, foci of osseous resorption permeated by squamous epithelium were visualized. In conclusion, oral CC should be considered in the differential diagnosis, especially when assessing persistent "reactive inflammatory process."
MUCOEPIDERMOID CARCINOMA OF THE PALATE: A CASE REPORT. AMANDA FEITOZA DA SILVA, JOHN LENNON SILVA CUNHA, KLINGER DE SOUZA AMORIM, FRANCISCO DE ASSIS ALMEIDA LIMA JUNIOR, CLAUBERTO RODRIGUES DE OLIVEIRA, LIANE MACIEL ALMEIDA DE SOUZA and, RICARDO LUIZ CAVALCANTI DE ALBUQUERQUE JUNIOR Mucoepidermoid carcinoma (MEC) is the most common malignant neoplasm of the salivary glands, accounting for 10% to 15% of all neoplasms in this region. We report a case of a 37year-old male patient with light brown skin color presenting an extensive tumor lesion located on the soft palate, which was hardened, ulcerated, and asymptomatic with 5 months of evolution. With the clinical differential diagnosis of a malignant salivary gland neoplasm, an incisional biopsy was carried out. Microscopic examination revealed intense proliferation of atypical squamous epithelial cells, permeated by mucous and clear cells, eventually forming cystic spaces. Tumor cells were positive for mucicarmine and PAS. The histopathologic diagnosis was high-grade MEC. The patient was referred to an oncology center for definitive surgical treatment and radiotherapy. After 1 year of follow-up no signs of relapse or locoregional or distant metastasis have been observed. A discussion on the clinical, histopathologic, and therapeutic aspects of MEC will be provided.
SCLEROTHERAPY OF A LOWER LIP VASCULAR MALFORMATION: CASE REPORT. LILIAN MACHADO DE SOUSA ALMEIDA, e NEZ THAYLLA NU AMIN DICK, LILIAN ROCHA SANTOS, KATRYNE DA COSTA, JULIANA PORTES DE OLIVEIRA, DANIELLE CASTEX CONDE and, JUNIOR ARLEY SILVA Clinically, a vascular malformation is characterized by a soft, red to purple papule or nodule with a moriform or smooth surface. The clinical aspects depend on the level of vascular congestion and the depth of the lesion. It is usually asymptomatic, and when the oral mucosa involved, it commonly affects the lips, tongue, and buccal mucosa. A 72-year-old black male patient came to our oral diagnosis clinic presenting a lesion with 10 years of evolution. Oral examination revealed a purple nodular lesion on the lower lip measuring 9.0 £ 9.0 cm, which had a positive result on diascopy. The clinical hypothesis was a vascular malformation. The treatment was sclerotherapy, and it was initiated
OOOO Volume 129, Number 1 with 5% of ethanolamine oleate, which was progressively concentrated up to 25%. A total remission of the lesion was seen after 8 weekly sessions of injection, and there are no signs of recurrence.
INTRA-ARTICULAR SYNOVIAL CHONDROMATOSIS: CLINICAL CASE REPORT. LETICIA e DRUMOND DE ABREU GUIMARAES, STEPHANIE KENIG VIVEIROS, DANIEL UIEDA and, FABIO DAUMAS NUNES Synovial chondromatosis is a rare, benign cartilaginous metaplasia that affects the joints, is uncommon in the temporomandibular joint (TMJ), and is difficult to diagnose because of its generally vague symptoms. In the present report we emphasize the importance of the correct diagnosis in a noncommon location. A male patient reported recurrent episodes of dislocation and pain in the left TMJ. In the clinical examination an oral opening limitation was observed, and tomographic sections showed hyperdense, circumscribed, well-defined area in the joint space, measuring approximately 2 mm. It was surgically removed, and the histologic slices revealed a hypocellular hyaline cartilage fragment whose gaps were filled by nonatypical chondrocytes. Therefore, the histopathologic study is essential to differentiate it from a chondrosarcoma. The patient is under follow-up and is without recurrences.
BASALOID SQUAMOUS CELL CARCINOMA OF THE MOUTH FLOOR: CASE REPORT. JOHN LENNON SILVA CUNHA, AMANDA FEITOZA DA SILVA, BRENO FERREIRA BARBOSA, FRANCISCO DE ASSIS ALMEIDA LIMA JUNIOR, CLAUBERTO RODRIGUES DE OLIVEIRA, MARCIA CRISTINA DA COSTA MIGUEL and, RICARDO LUIZ CAVALCANTI DE ALBUQUERQUE JUNIOR Basaloid squamous cell carcinoma (BSCC) is a rare aggressive variant of squamous cell carcinoma (SCC). We report a case of a 42-year-old male patient, a smoker and alcoholic, presenting a painless erythroleukoplakia lesion in the floor of the mouth, measuring approximately 2.5 cm in diameter with 5 months of evolution. There were bilateral palpable submandibular lymph nodes. The presumptive diagnosis was SCC, and an incisional biopsy was carried out. Pathologic analysis revealed proliferation of nests, islands, and trabeculae of basaloid cells with hyperchromatic nuclei and scarce cytoplasm. An atypical squamous component was evident in some regions of the specimen. Immunohistochemical analysis revealed intense positivity for CK14 and P16 and negativity for CK7. The diagnosis was BSCC. The patient was referred to a public head and neck oncology service for definitive surgical treatment and radiotherapy. A discussion on the clinical, histopathologic, immunohistochemical, and therapeutic aspects of BSCC will be provided.
OZONE THERAPY IN THE TREATMENT OF OSTEONECROSIS OF THE JAW: A CASE REPORT. THAIS SANTOS CERQUEIRA, CESAR WERNECK NOCE DOS SANTOS, NATHALIA DE ALMEIDA FREIRE, ERIKA CASTRO KUZSMINSZKY, e SUSINI GIULIANNA LIMA PINHEIRO, ISABELA SIMOES RIBEIRO and, BEATRIZ DA ROCHA MIRANDA VENTURI
ABSTRACTS
e91
Osteonecrosis of the jaw has been reported in several patients who have used or are using bisphosphonates by oral or intravenous route. The treatment of (ONJ) includes the administration of local and systemic antibiotics and surgical intervention. Ozone therapy is indicated to treat these injuries, promoting the repair of bone tissue, avoiding invasive procedures, and reducing the use of antibiotics, which is extremely important for elderly and compromised patients. A 74-year-old female patient on chemotherapy treatment with cetuximab for colorectal cancer returned after dental extraction of #38 with incomplete wound healing, pain on palpation, soft tissue depression, and mild bone exposure. In the following case report, we show the efficacy of a 21-day course of antibiotic and 2 weekly applications of ozone followed by a simple sequestrectomy with primary wound closure. In the 8-month follow-up of the patient the clinical aspect of the treated region was normal before the treatment.
TRICHILEMMAL CYST: A POSSIBLY MALIGNANT RARE INJURY IN UPPER LIP - CASE REPORT. NICHOLAS PASCUOTTE FILIPPETTI, BRENDA SOARES DO SANTOS and, ELIANE DOS ANJOS QUEIROZ Trichilemmal cyst is a rare cyst, with small incidence in mouth, which can affect both sexes; however, is more common in women, having the possibility to become malignant. Its pathogenesis is related to the sebaceous glands ducts obstruction leading to the retention of secretion, being filled by keratin. Its occurrence is more common in hairy regions or close to them. A 54-year-old man arrived with the main complaint of "a little ball that moved back and forward in the upper lip." The physical examination reported the presence of a nodule measuring 5 mm, which was mobile, painless, and covered with normal mucosa. After image and blood complementary examinations, an excisional biopsy with small safety margin was performed. The anatomopathologic examination result was trichilemmal cyst. The patient remains asymptomatic and without relapse signals. His prognosis is favorable.
REACTION IN ORAL MUCOSA DUE TO INTENSIVE THERAPY POLYPHARMACY: CASE REPORT. ANDRESSA COUTINHO RIBEIRO, CLAUDIA CRISTIANE BAISEREDO DE e CARVALHO, ANA FLAVIA SCHUELER DE ASSUMPC ¸ AO LEITE, ADRIANA TEREZINHA NEVES NOVELLINO ALVES, SIMONE DE QUEIROZ CHAVES LOURENCO ¸ and, JOSIANE COSTA RODRIGUES DE SA A 51-year-old white female patient hospitalized in the intensive care unit because of acute ischemic stroke who needed tracheostomy and vasoactive drugs in high dosage evolved with aspiration pneumonia and septic shock. At 30 days of hospitalization, intraoral examination revealed multiple superficial ulcers on the lips, buccal mucosa, tongue, and mouth floor, circumscribed by erythematous halo and covered by pseudomembrane with severe pain symptomatology and evolution of 15 days. Concomitantly, the patient presented bilateral conjunctivitis with erythema in the sclera and periocular region. Several medications were used during hospitalization. Diagnostic hypotheses were erythema multiforme, mucous membrane pemphigoid, and paraneoplastic pemphigus. Incisional biopsy was performed. Histopathologic analysis was suggestive of erythema multiforme. Final diagnosis after clinical correlation was erythema multiforme. Treatment consisted
e90
PARACOCCIDIOIDOMYCOSIS OF THE CHEEK: CASE REPORT. AMANDA FEITOZA DA SILVA, JOHN LENNON SILVA CUNHA, ALLAN ULISSES DE CARVALHO MELO, ENRIK BARBOSA DE ALMEIDA, CLAUBERTO RODRIGUES DE OLIVEIRA, JULIANA CAMPOS PINHEIRO and, RICARDO LUIZ CAVALCANTI DE ALBUQUERQUE JUNIOR Paracoccidioidomycosis (PCM) is a disease caused by the fungus Paracoccidioides brasiliensis, which is common in Brazil and some other areas in Latin America. We report a case of a 50-yearold male patient, a farm worker and smoker, presenting an asymptomatic ulcerated lesion with moriform appearance in the left buccal mucosa and uncertain time of evolution. The presumptive diagnosis was PCM. The patient underwent incisional biopsy, and histopathologic analysis revealed pseudoepitheliomatous hyperplasia and granulomatous inflammatory reaction. Ovoid yeasts with birefringent membrane were also evidenced. Grocott-stained slices demonstrated the presence of microorganisms exhibiting multiple buddings (ships wheel appearances) and double buddings (Mickey Mouse ears). The diagnosis was PCM. The patient was referred to the infectious diseases specialist for treatment of the lesion. Although PCM affects lungs primarily, it is often diagnosed through oral manifestation. Thus, dentists play a fundamental role in the identification of these lesions and referral for appropriate treatment.
ORAL MANIFESTATIONS OF CROHN DISEASE: A CASE REPORT. KAREN LOUREIRO WEIGERT, MARTA BRENNER MACHADO, EDELA PURICELLI, MILTON CRISTIAN COUGO, JESSICA MUNARETTO and, GILBERTO VAUTHIER Crohn disease is an inflammatory chronic, relapsing, immune-mediated disorder of the gastrointestinal tract. Any part of the tract may be involved. We describe a case of a 45-year-old man with Crohn disease and hepatitis C virus genotype 1 a. Previous treatments kept him stable for 21 years. In December 2017, he developed mandibular vestibule ulcers, mucogingivitis, and cobblestones on the buccal mucosa. The patient took prednisolone 20 mg and infliximab, and biopsy of the buccal lesions revealed lymphoplasmacytic infiltration. He went through 4 photodynamic therapy sessions and 10 laser therapy sessions. He had short remission; however, 3 months later new linear ulcers, swelling, pain, and perianal lesions appeared. Microbiologic analysis taken from the oral mucosa did not reveal positive cultures. After these findings, drug treatment was changed, and the patient is currently in the first dose of ustekinumab, 40 mg of prednisone (Meticorten), laser therapy, and topical administration of clobetasol, already showing reduction of manifestations.
GINGIVAL CARCINOMA CUNICULATUM: RARE VARIANT OF SQUAMOUS CELL CARCINOMA OFTEN MISDIAGNOSED AS AN INFLAMMATORY PROCESS. RODRIGO NEVES-SILVA, ALEXANDRE ELIAS TRIVELLATO, CASSIO EDVARD SVERZUT, CARLA BENTO NELEM COLTURATO, LUCIANA YAMAMOTO ALMEIDA, KELLY FERNANDA MOLENA and, JORGE ESQUICHE LEON Carcinoma cuniculatum (CC) is a rare variant of oral squamous cell carcinoma (OSCC). To date, 50 cases of oral CC have
OOOO January 2020 been reported. A 67-year-old white female patient presented complaining of a painless tumor mass in the left mandibular body with several months of evolution. Previous dental history indicated extraction of teeth #37 and #38 and chronic osteomyelitis. Intraoral examination revealed an irregular exophytic mass in the region of the extracted teeth, which exhibited a yellow purulent discharge during palpation. Radiograph evidenced an osteolytic lesion with irregular and ill-defined borders. An incisional biopsy was performed, which showed an intense squamous epithelial proliferation, with frequent invaginations that delimited pseudocystic cavities filled with parakeratin and peeled cells. In the deepest part, foci of osseous resorption permeated by squamous epithelium were visualized. In conclusion, oral CC should be considered in the differential diagnosis, especially when assessing persistent "reactive inflammatory process."
MUCOEPIDERMOID CARCINOMA OF THE PALATE: A CASE REPORT. AMANDA FEITOZA DA SILVA, JOHN LENNON SILVA CUNHA, KLINGER DE SOUZA AMORIM, FRANCISCO DE ASSIS ALMEIDA LIMA JUNIOR, CLAUBERTO RODRIGUES DE OLIVEIRA, LIANE MACIEL ALMEIDA DE SOUZA and, RICARDO LUIZ CAVALCANTI DE ALBUQUERQUE JUNIOR Mucoepidermoid carcinoma (MEC) is the most common malignant neoplasm of the salivary glands, accounting for 10% to 15% of all neoplasms in this region. We report a case of a 37year-old male patient with light brown skin color presenting an extensive tumor lesion located on the soft palate, which was hardened, ulcerated, and asymptomatic with 5 months of evolution. With the clinical differential diagnosis of a malignant salivary gland neoplasm, an incisional biopsy was carried out. Microscopic examination revealed intense proliferation of atypical squamous epithelial cells, permeated by mucous and clear cells, eventually forming cystic spaces. Tumor cells were positive for mucicarmine and PAS. The histopathologic diagnosis was high-grade MEC. The patient was referred to an oncology center for definitive surgical treatment and radiotherapy. After 1 year of follow-up no signs of relapse or locoregional or distant metastasis have been observed. A discussion on the clinical, histopathologic, and therapeutic aspects of MEC will be provided.
SCLEROTHERAPY OF A LOWER LIP VASCULAR MALFORMATION: CASE REPORT. LILIAN MACHADO DE SOUSA ALMEIDA, e NEZ THAYLLA NU AMIN DICK, LILIAN ROCHA SANTOS, KATRYNE DA COSTA, JULIANA PORTES DE OLIVEIRA, DANIELLE CASTEX CONDE and, JUNIOR ARLEY SILVA Clinically, a vascular malformation is characterized by a soft, red to purple papule or nodule with a moriform or smooth surface. The clinical aspects depend on the level of vascular congestion and the depth of the lesion. It is usually asymptomatic, and when the oral mucosa involved, it commonly affects the lips, tongue, and buccal mucosa. A 72-year-old black male patient came to our oral diagnosis clinic presenting a lesion with 10 years of evolution. Oral examination revealed a purple nodular lesion on the lower lip measuring 9.0 £ 9.0 cm, which had a positive result on diascopy. The clinical hypothesis was a vascular malformation. The treatment was sclerotherapy, and it was initiated
OOOO Volume 129, Number 1 with 5% of ethanolamine oleate, which was progressively concentrated up to 25%. A total remission of the lesion was seen after 8 weekly sessions of injection, and there are no signs of recurrence.
INTRA-ARTICULAR SYNOVIAL CHONDROMATOSIS: CLINICAL CASE REPORT. LETICIA e DRUMOND DE ABREU GUIMARAES, STEPHANIE KENIG VIVEIROS, DANIEL UIEDA and, FABIO DAUMAS NUNES Synovial chondromatosis is a rare, benign cartilaginous metaplasia that affects the joints, is uncommon in the temporomandibular joint (TMJ), and is difficult to diagnose because of its generally vague symptoms. In the present report we emphasize the importance of the correct diagnosis in a noncommon location. A male patient reported recurrent episodes of dislocation and pain in the left TMJ. In the clinical examination an oral opening limitation was observed, and tomographic sections showed hyperdense, circumscribed, well-defined area in the joint space, measuring approximately 2 mm. It was surgically removed, and the histologic slices revealed a hypocellular hyaline cartilage fragment whose gaps were filled by nonatypical chondrocytes. Therefore, the histopathologic study is essential to differentiate it from a chondrosarcoma. The patient is under follow-up and is without recurrences.
BASALOID SQUAMOUS CELL CARCINOMA OF THE MOUTH FLOOR: CASE REPORT. JOHN LENNON SILVA CUNHA, AMANDA FEITOZA DA SILVA, BRENO FERREIRA BARBOSA, FRANCISCO DE ASSIS ALMEIDA LIMA JUNIOR, CLAUBERTO RODRIGUES DE OLIVEIRA, MARCIA CRISTINA DA COSTA MIGUEL and, RICARDO LUIZ CAVALCANTI DE ALBUQUERQUE JUNIOR Basaloid squamous cell carcinoma (BSCC) is a rare aggressive variant of squamous cell carcinoma (SCC). We report a case of a 42-year-old male patient, a smoker and alcoholic, presenting a painless erythroleukoplakia lesion in the floor of the mouth, measuring approximately 2.5 cm in diameter with 5 months of evolution. There were bilateral palpable submandibular lymph nodes. The presumptive diagnosis was SCC, and an incisional biopsy was carried out. Pathologic analysis revealed proliferation of nests, islands, and trabeculae of basaloid cells with hyperchromatic nuclei and scarce cytoplasm. An atypical squamous component was evident in some regions of the specimen. Immunohistochemical analysis revealed intense positivity for CK14 and P16 and negativity for CK7. The diagnosis was BSCC. The patient was referred to a public head and neck oncology service for definitive surgical treatment and radiotherapy. A discussion on the clinical, histopathologic, immunohistochemical, and therapeutic aspects of BSCC will be provided.
OZONE THERAPY IN THE TREATMENT OF OSTEONECROSIS OF THE JAW: A CASE REPORT. THAIS SANTOS CERQUEIRA, CESAR WERNECK NOCE DOS SANTOS, NATHALIA DE ALMEIDA FREIRE, ERIKA CASTRO KUZSMINSZKY, e SUSINI GIULIANNA LIMA PINHEIRO, ISABELA SIMOES RIBEIRO and, BEATRIZ DA ROCHA MIRANDA VENTURI
ABSTRACTS
e91
Osteonecrosis of the jaw has been reported in several patients who have used or are using bisphosphonates by oral or intravenous route. The treatment of (ONJ) includes the administration of local and systemic antibiotics and surgical intervention. Ozone therapy is indicated to treat these injuries, promoting the repair of bone tissue, avoiding invasive procedures, and reducing the use of antibiotics, which is extremely important for elderly and compromised patients. A 74-year-old female patient on chemotherapy treatment with cetuximab for colorectal cancer returned after dental extraction of #38 with incomplete wound healing, pain on palpation, soft tissue depression, and mild bone exposure. In the following case report, we show the efficacy of a 21-day course of antibiotic and 2 weekly applications of ozone followed by a simple sequestrectomy with primary wound closure. In the 8-month follow-up of the patient the clinical aspect of the treated region was normal before the treatment.
TRICHILEMMAL CYST: A POSSIBLY MALIGNANT RARE INJURY IN UPPER LIP - CASE REPORT. NICHOLAS PASCUOTTE FILIPPETTI, BRENDA SOARES DO SANTOS and, ELIANE DOS ANJOS QUEIROZ Trichilemmal cyst is a rare cyst, with small incidence in mouth, which can affect both sexes; however, is more common in women, having the possibility to become malignant. Its pathogenesis is related to the sebaceous glands ducts obstruction leading to the retention of secretion, being filled by keratin. Its occurrence is more common in hairy regions or close to them. A 54-year-old man arrived with the main complaint of "a little ball that moved back and forward in the upper lip." The physical examination reported the presence of a nodule measuring 5 mm, which was mobile, painless, and covered with normal mucosa. After image and blood complementary examinations, an excisional biopsy with small safety margin was performed. The anatomopathologic examination result was trichilemmal cyst. The patient remains asymptomatic and without relapse signals. His prognosis is favorable.
REACTION IN ORAL MUCOSA DUE TO INTENSIVE THERAPY POLYPHARMACY: CASE REPORT. ANDRESSA COUTINHO RIBEIRO, CLAUDIA CRISTIANE BAISEREDO DE e CARVALHO, ANA FLAVIA SCHUELER DE ASSUMPC ¸ AO LEITE, ADRIANA TEREZINHA NEVES NOVELLINO ALVES, SIMONE DE QUEIROZ CHAVES LOURENCO ¸ and, JOSIANE COSTA RODRIGUES DE SA A 51-year-old white female patient hospitalized in the intensive care unit because of acute ischemic stroke who needed tracheostomy and vasoactive drugs in high dosage evolved with aspiration pneumonia and septic shock. At 30 days of hospitalization, intraoral examination revealed multiple superficial ulcers on the lips, buccal mucosa, tongue, and mouth floor, circumscribed by erythematous halo and covered by pseudomembrane with severe pain symptomatology and evolution of 15 days. Concomitantly, the patient presented bilateral conjunctivitis with erythema in the sclera and periocular region. Several medications were used during hospitalization. Diagnostic hypotheses were erythema multiforme, mucous membrane pemphigoid, and paraneoplastic pemphigus. Incisional biopsy was performed. Histopathologic analysis was suggestive of erythema multiforme. Final diagnosis after clinical correlation was erythema multiforme. Treatment consisted