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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 42-year-old male patient was seen at the Dermatology Service due to the presence of whitish lesions on the oral mucosa&#44; affecting mainly the tongue&#46; Moreover&#44; he reported significant dysgeusia and a lack of appetite&#46; He had chronic kidney disease and had been undergoing conservative treatment so far&#46; The examination of the oral cavity showed whitish plaques with threadlike projections adhered to the lateral borders of the tongue &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41; and a white plaque on the left cheek mucosa &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; He had ketone breath on examination&#46; The patient was awaiting dialysis and had a serum creatinine level of 17&#8239;mg&#47;dL&#44; with uremia of 200&#8239;mg&#47;dL&#46; After a few hemodialysis sessions&#44; the lesions regressed significantly&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Uremic stomatitis is an underreported disease of the oral mucosa&#44; possibly associated with long-term uremia in patients with chronic kidney disease&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It was first mentioned by Lancereaux in 1887 and described by Barie in 1889 as an uncommon but characteristic complication of advanced kidney disease&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It has a low incidence<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> which notably decreased with the advent of dialysis&#44; and is rarely seen nowadays&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The etiology remains unknown&#44; and it has been suggested that it may be due to high levels of ammonia compounds&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Ammonia is formed through the action of bacterial ureases that modify salivary urea&#44; which is elevated in renal patients&#46; The clinical characteristics are poorly defined and are rarely detailed in publications&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The affected patients may complain of pain&#44; dysgeusia&#44; and a burning sensation&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a> Four clinical types of uremic stomatitis have been described&#58; pseudomembranous&#44; ulcerative&#44; hemorrhagic&#44; and hyperkeratotic&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The ulcerative type is the most common&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> with an erythematous appearance&#44; and the hyperkeratotic type is a rare alteration that can occur in long-term renal failure&#46; Diagnosis is based on clinical signs and symptoms&#44; and histopathology is characterized by epithelial hyperplasia and unusual hyperparakeratinization&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a> Lichen planus&#44; hypertrophic candidiasis&#44; oral hairy leukoplakia&#44; and vitamin deficiencies are important differential diagnoses&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The treatment consists in improving blood urea levels&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The manifestations usually persist for two to three weeks&#46; Hydrogen peroxide washes can contribute to the elimination of anaerobic bacteria that produce ammonia&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Despite the high frequency of patients with kidney disease&#44; only a few cases of uremic stomatitis have been published&#46; Investigations are required for a better understanding of the pathogenic mechanism of this disorder&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0015" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0020" class="elsevierStylePara elsevierViewall">Paulo Ricardo Martins Souza&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Gabriela Mosena&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Manuela Lima Dantas&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Gerson Vettorato&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Case Letter
Uremic stomatitis
Paulo Ricardo Martins Souzaa,b, Gabriela Mosenac,
Autor para correspondência
gabriela.mosena@gmail.com

Corresponding author.
, Manuela Lima Dantasd, Gerson Vettoratod
a Dermatology Service, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
b Department of Dermatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
c Clínica Privada de Dermatologia, Caxias do Sul, RS, Brazil
d Clínica Privada de Dermatologia, Porto Alegre, RS, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 42-year-old male patient was seen at the Dermatology Service due to the presence of whitish lesions on the oral mucosa&#44; affecting mainly the tongue&#46; Moreover&#44; he reported significant dysgeusia and a lack of appetite&#46; He had chronic kidney disease and had been undergoing conservative treatment so far&#46; The examination of the oral cavity showed whitish plaques with threadlike projections adhered to the lateral borders of the tongue &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41; and a white plaque on the left cheek mucosa &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; He had ketone breath on examination&#46; The patient was awaiting dialysis and had a serum creatinine level of 17&#8239;mg&#47;dL&#44; with uremia of 200&#8239;mg&#47;dL&#46; After a few hemodialysis sessions&#44; the lesions regressed significantly&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Uremic stomatitis is an underreported disease of the oral mucosa&#44; possibly associated with long-term uremia in patients with chronic kidney disease&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It was first mentioned by Lancereaux in 1887 and described by Barie in 1889 as an uncommon but characteristic complication of advanced kidney disease&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It has a low incidence<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> which notably decreased with the advent of dialysis&#44; and is rarely seen nowadays&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The etiology remains unknown&#44; and it has been suggested that it may be due to high levels of ammonia compounds&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Ammonia is formed through the action of bacterial ureases that modify salivary urea&#44; which is elevated in renal patients&#46; The clinical characteristics are poorly defined and are rarely detailed in publications&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The affected patients may complain of pain&#44; dysgeusia&#44; and a burning sensation&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a> Four clinical types of uremic stomatitis have been described&#58; pseudomembranous&#44; ulcerative&#44; hemorrhagic&#44; and hyperkeratotic&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The ulcerative type is the most common&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> with an erythematous appearance&#44; and the hyperkeratotic type is a rare alteration that can occur in long-term renal failure&#46; Diagnosis is based on clinical signs and symptoms&#44; and histopathology is characterized by epithelial hyperplasia and unusual hyperparakeratinization&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a> Lichen planus&#44; hypertrophic candidiasis&#44; oral hairy leukoplakia&#44; and vitamin deficiencies are important differential diagnoses&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The treatment consists in improving blood urea levels&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The manifestations usually persist for two to three weeks&#46; Hydrogen peroxide washes can contribute to the elimination of anaerobic bacteria that produce ammonia&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Despite the high frequency of patients with kidney disease&#44; only a few cases of uremic stomatitis have been published&#46; Investigations are required for a better understanding of the pathogenic mechanism of this disorder&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0015" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0020" class="elsevierStylePara elsevierViewall">Paulo Ricardo Martins Souza&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Gabriela Mosena&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Manuela Lima Dantas&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Gerson Vettorato&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Informação do artigo
ISSN: 03650596
Idioma original: Inglês
DOI:10.1016/j.abd.2020.09.019
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