儿童苔藓样肉芽肿性口炎1例报道及文献回顾

Childhood lichenoid granulomatous stomatitis: a case report and literature review

摘要

目的 探讨口腔苔藓样损害的分类、临床表现、诊断、鉴别诊断及治疗，为临床提供参考。方法 获得医院伦理审批及患者知情同意，报道 1 例儿童口腔苔藓样损害病例，结合文献对口腔苔藓样损害的诊疗进行回顾分析。结果 患儿舌背反复破溃伴疼痛3年余，舌背大面积糜烂面，形状不规则，糜烂周围见珠光白色纹，左侧糜烂区伴组织增生，约1.5 cm × 2.0 cm，质地韧，宽蒂。舌背白色网纹组织切取活检病理诊断为苔藓样损害；舌背增生物切除活检病理诊断为苔藓样损害伴肉芽肿性炎。根据患者口内损害特征、系统病史、用药史、组织病理学检查结果，最终诊断为苔藓样肉芽肿性口炎。文献回顾表明，口腔苔藓样损害病因不明，临床上需与口腔扁平苔藓、口腔苔藓样药物反应、口腔苔藓样接触性损害、慢性溃疡性口炎等疾病鉴别。临床上治疗口腔苔藓样损害以糖皮质激素的局部和/或全身使用为主。结论 目前口腔苔藓样损害的分类和诊断仍无统一标准，主要依靠病史询问、临床表现和组织病理学检查结果，治疗方法主要为糖皮质激素的局部和/或全身使用。

Abstract

Objective To investigate the classification, clinical manifestations, diagnosis, differential diagnosis and treatment of oral lichenoid lesions and provide a reference for clinical practice. Methods Hospital ethical approval and patient informed consent were obtained. We report a case of oral lichenoid lesion in children and review the diagnosis and treatment of oral lichenoid damage in the literature. Results The patient experienced repeated rupture of the dorsal surface of the tongue with pain for more than 3 years. There was a large area of tongue back surface erosion with an irregular shape, surrounded by pearly-white lines. The left erosive area was accompanied by tissue hyperplasia, which was approximately 1.5 cm × 2.0 cm, with tough texture and broad masses. The pathological diagnosis of the patient was oral lichenoid lesion. After biopsy of the dorsal surface of the tongue, the pathological diagnosis of the patient was granulomatous inflammation. The final diagnosis of lichenoid granulomatous stomatitis was made on the basis of the patient's intraoral damage features, systemic history, medication history and histopathological findings. A review of the literature suggests that oral lichenoid lesions have an unknown etiology and need to be clinically differentiated from oral lichen planus, oral lichenoid drug reactions, oral lichenoid contact damage and chronic ulcerative stomatitis. The clinical treatment of oral lichen planus is based on the topical and/or systemic use of glucocorticoids. Conclusion There are still no uniform criteria for the classification and diagnosis of oral lichenoid lesions. They rely mainly on history taking, clinical manifestations and histopathological findings, and the treatment is mainly based on the topical and/or systemic use of glucocorticoids.

关键词

口腔苔藓样损害 / 苔藓样肉芽肿性口炎 / 口腔扁平苔藓 / 口腔苔藓样药物反应 / 口腔苔藓样接触性损害 / 移植物抗宿主病相关性苔藓样损害 / 慢性溃疡性口炎 / 类天疱疮样扁平苔藓 / 儿童 / 糖皮质激素

Key words

oral lichenoid lesions / lichenoid granulomatous stomatitis / oral lichen planus / oral lichenoid drug reaction / oral lichenoid contact lesion / oral lichenoid lesion of graft-versus-host disease / chronic ulcerative stomatitis / lichen planus pemphigoides / children / glucocorticoids

Author summay

徐婧，医师，本科，Email: [e-mail]