Screening of erythematous petechiae and macules as indicators of systemic diseases: a case report

Abstract

Oral mucosa alterations can be part of screening for various diseases. A 39-year-old white woman, with lower lip erythematous macules for 5 years, worsting in 2 months with bleeding upon minimal trauma and healing delay. History of 10 years of working sun overexposure, treated anemia, no chronic medication. Current blood tests are within normal limits. Labial mucosa, gingiva, dorsum of the tongue, buccal mucosa, and fingertips presented erythematous petechiae. Lower lip incisional biopsy reported capillary hemangioma. Clinical diagnosis pointed toward hereditary hemorrhagic telangiectasia, as the patient reported recurrent spontaneous epistaxis and her 18-year-old daughter exhibited similar symptoms. Differential diagnosis was considered for CREST syndrome. She was referred to a physician to investigate possible arteriovenous malformations involving the lungs, liver, or central nervous system. Lip lesions were successfully treated with ethanolamine. The dentist can play a decisive role in the diagnosis of systemic diseases if he thoroughly explores the whole patient's history.