Multisystem inflammatory syndrome in adults (MIS-A) is a severe postinfectious complication of COVID-19. Renal involvement is common; however, histopathological findings have not been adequately characterised. We here report a case of a previously healthy man in his 60s who developed persistent fever, diarrhoea, glossitis and digital swelling approximately 3 weeks after COVID-19 infection. Antibiotic therapy was ineffective and renal function deteriorated. He was diagnosed with MIS-A and corticosteroid therapy produced marked clinical improvement. He was discharged 3 weeks after hospital admission. Renal biopsy demonstrated medullary haemorrhagic interstitial nephritis with preserved cortex, an uncommon pathological finding in renal injury secondary to COVID-19, which is consistent with possible immune-mediated endothelial injury.This case highlights medullary haemorrhagic interstitial nephritis as a potential pathological manifestation of MIS-A and illustrates a diagnostic pitfall. Recognition of MIS-A is essential for timely corticosteroid treatment and prevention of life-threatening multiorgan failure.

Herpetic geometric glossitis (HGG) is a rare, atypical manifestation of herpes simplex virus type 1 (HSV-1) infection, most commonly reported in immunocompromised individuals. We report a case of a 43-year-old immunocompetent male presenting with edematous heme-crusted lips, fissured tongue, and severe oral pain, leading to significant oral intake limitation and subsequent inpatient admission. Dermatology was consulted for possible Stevens-Johnson syndrome, which was ruled out following evaluation. Clinical findings were consistent with HGG, an uncommon presentation of HSV infection. The patient started empiric antiviral therapy, leading to symptom improvement, and HSV-1 polymerase chain reaction testing returned positive, confirming the diagnosis. This case highlights a rare presentation of HSV-1 in an immunocompetent host and emphasizes the importance of recognizing atypical morphologic variants to guide timely diagnosis and management.

Cytomegalovirus (CMV) is an opportunistic pathogen that can rarely cause ulcerative lesions of the oral mucosa in immunocompromised patients, although such manifestations often mimic other infectious, inflammatory, or traumatic etiologies. We report the case of a two-year-eight-month-old child with B-cell acute lymphoblastic leukemia undergoing blinatumomab therapy as a bridge to hematopoietic stem cell transplantation, who developed atypical, painless erosive glossitis. Clinical examination revealed polycyclic aphthoid lesions on the dorsum of the tongue in an afebrile, immunosuppressed patient. Virological polymerase chain reaction performed on lesion swabs and plasma detected CMV DNA, whereas tests for herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, and enterovirus, as well as mycological microscopic examination, were negative. These findings supported the diagnosis of CMV-associated ulcerative glossitis. The lesions resolved following discontinuation of blinatumomab and initiation of empirical antiviral and antifungal therapy. This case highlights the diagnostic challenges of CMV mucosal involvement in immunocompromised hosts, particularly in the absence of classic ulcerative features or confirmatory tissue biopsy. Detection of CMV in mucosal swabs requires careful interpretation, as asymptomatic shedding is common. Recognizing such atypical presentations is essential to guide appropriate diagnostic workup and therapeutic decision-making in high-risk pediatric oncology patients.

In honor of the new section on Forensic Dermatology that appears in Clinics in Dermatology, we present a modern-day detective story we created based on Sherlock Holmes, the famous fictional character created by Sir Arthur Conan Doyle (1859-1930). In our tale, a victim suspects that he is being slowly poisoned. An alteration of the victim's tongue (atrophic glossitis) and jaundice provide diagnostic forensic dermatologic clues. The serum toxicology is negative, and the police find no evidence of common poisons in the household. Sherlock Holmes, however, suspects foul play and must solve the crime to save the victim's life.

During the course of targeted drug therapy, a cancer patient may manifest a myriad of systemic and oral toxicities. This has a direct impact on the patient's QOL. This clinical image highlights a rarely-encountered oral mucosal alteration called benign migratory glossitis in a case of cholangiocarcinoma who was subjected to bevacizumab.

IntroductionBased on the FAERS database, this retrospective pharmacovigilance study analyzed gender-based reporting signals for adverse events associated with three EGFR-TKIs.MethodsAdverse drug reaction (ADR) data were collected from the FAERS database for three drugs: gefitinib (Q4 2003-Q4 2024), afatinib (Q4 2013-Q4 2024), and osimertinib (Q4 2015-Q4 2024). Reporting odds ratio (ROR) was used to detect the disproportionality signals and to assess the presence of gender differences in reporting.ResultsA total of 6,618 adverse events were reported for gefitinib (3,917 in females and 2,701 in males), 5,073 for afatinib (3,110 in females and 1,963 in males), and 18,415 for osimertinib (12,007 in females and 6,408 in males). For all three medications, the annual number of adverse drug event (ADE) reports was higher in females than in males. The ROR value and number of ADE reports under the SOC distribution indicated predominant reporting signals of skin and gastrointestinal adverse reactions. Gender-specific analysis of skin and gastrointestinal ADEs revealed that: (i) Gefitinib showed higher reporting signals for intestinal pneumatosis and skin ulcers in females; (ii) Afatinib showed higher reporting signals for acneiform dermatitis and oral pain in females, while males showed a higher reporting frequency of stomatitis and glossitis; (iii) Osimertinib showed higher reporting signals for diarrhea in females. These observed reporting disparities generate hypotheses regarding potential contributing factors, such as gender-based differences in hormone levels, gastrointestinal tract anatomy, and skin barrier function.ConclusionsThis pharmacovigilance analysis suggests the presence of sex-based reporting disparities in adverse event reports for three EGFR-TKIs. Females showed overall stronger reporting signals, with notable differences observed in specific skin and gastrointestinal events. Although the analysis has certain limitations, these findings generate hypotheses to inform future focused investigations.

Riboflavin (vitamin B2) is a water-soluble, heat-stable vitamin essential for cellular energy metabolism, acting as a precursor to the coenzymes flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD). These cofactors are required by flavoproteins such as succinate dehydrogenase (Complex II), which participate in both the citric acid cycle and the mitochondrial electron transport chain, enabling adenosine triphosphate (ATP) production, maintaining redox balance, and supporting antioxidant defenses. Beyond energy metabolism, riboflavin contributes to immune function and to maintaining the health of skin, hair, and mucous membranes. Deficiency disrupts these pathways, leading to fatigue, normocytic anemia, neuromuscular symptoms, and secondary impairments in iron and other B-vitamin metabolism, including the activation of niacin (vitamin B3) and pyridoxine (vitamin B6). Because humans cannot synthesize riboflavin, adequate dietary intake is necessary, and absorption depends on normal gastrointestinal function. Excess riboflavin is excreted in urine, producing the characteristic yellow color that indicates adequate intake. Clinical deficiency is characterized by mucocutaneous manifestations (cheilosis, angular stomatitis, glossitis, dermatitis) and anemia; in severe or prolonged cases, it may lead to neurologic or ocular metabolic abnormalities, reduced physical performance, and developmental problems. Emerging evidence also links riboflavin deficiency to psoriasis, with decreased intake associated with a higher risk and upregulated riboflavin metabolism observed in psoriatic skin, suggesting a protective role for adequate riboflavin status, particularly in individuals older than 40 years. This article reviews the etiology, epidemiology, pathophysiology, clinical presentation, evaluation, management, complications, and prognosis of riboflavin deficiency. The article also highlights the roles of patient education and interprofessional healthcare team collaboration in optimizing patient outcomes.

Systemic diseases frequently manifest through characteristic oral lesions, making the oral cavity an important indicator of underlying medical conditions. Therefore, it is of interest to assess the prevalence and patterns of oral lesions among patients with confirmed systemic diseases in a hospital-based population. Hence, a cross-sectional observational analysis of 500 adults was conducted, documenting demographic data, systemic diagnoses and clinically verified oral findings, which were evaluated using WHO criteria and analyzed statistically. The results demonstrated high frequencies of periodontal disease, candidiasis, glossitis, aphthous ulcers and lichenoid reactions, with distinct associations observed between specific lesions and conditions such as diabetes mellitus, hypertension, anemia, gastrointestinal disorders, autoimmune diseases and chronic kidney disease. These findings highlight the essential role of routine oral examination in the early detection and multidisciplinary management of systemic diseases.

Twenty-two herpesviruses, all within the family Orthoherpesviridae and belonging to the Alphaherpesvirinae (n = 3) and Gammaherpesvirinae (n = 19) subfamilies have been reported in 14 different pinniped species (n = 8 phocids, n = 5 otariids and n = 1 odobenid). This review critically assessed the purported pathology reported for herpesvirus infections and found a variety of lesions present dependent on both the herpesvirus and host species. Lesions included hepatic and adrenal necrosis, interstitial pneumonia, thyroid atrophy, lymphodepletion, lymphocytolysis, ulcerative stomatitis, glossitis with tonsilitis and dermatitis, necrotizing keratitis and, potentially, other ocular lesions also. Furthermore, specific individual gammaherpesvirus infections were linked to oncogeneses including urogenital carcinoma, diffuse large B cell lymphoma and B cell lymphoblastic lymphoma. However, for many herpesvirus infections the clinical significance, lesion association and definitive herpesvirus classification remain uncertain, the latter due to lack of sufficient genome data. For these reasons, identification of the definitive host species or even if separately reported herpesviruses are actually the same virus, remain challenging. More extensive genome sequencing is required to definitively identify and classify individual herpesvirus species along with sensitive and specific tools to visualize them within tissues to enable investigation of lesion association.

Systemic diseases often have oral manifestations that can significantly impact oral health. These manifestations can stem from hematological, gastrointestinal, and viral infections, resulting in various alterations within the oral cavity. Recognizing the crucial link between general and oral health, this research aims to evaluate the awareness of dental students and interns regarding the oral manifestations of systemic diseases. A cross-sectional study involving 244 dental students, including clinical stage dental students from the Faculty of Dentistry at the University of Damascus and intern dentists, was conducted. Participants completed a survey assessing their knowledge and sources of information about oral manifestations of systemic diseases. Additionally, they answered questions pertaining to oral manifestations of gastrointestinal diseases, viral infections, and hematological disorders, alongside inquiries about investigations warranted when observing oral lesions. The participants' awareness levels were categorized as excellent, good, intermediate, or poor. Awareness levels were assessed based on the percentage of correct responses. The study demonstrated that awareness of the oral manifestations of gastrointestinal diseases ranged between intermediate and good, knowledge levels of 71.3% for inflammatory bowel diseases and 55.7% for Crohn's disease. Conversely, awareness regarding the oral manifestations of viral infections was notably lower, with poor knowledge observed for hepatitis viruses (11.5%) and COVID-19 (28.85%), while intermediate awareness was recorded for viruses associated with nasopharyngeal carcinoma (39.55%). Regarding hematological disorders, awareness was good for conditions associated with gingival bleeding (62.3%) and glossitis (70.5%). However, intermediate levels of knowledge were noted for disorders presented with aphthous ulcers (56.84%), submucosal bleeding and hemorrhagic ulcers (43.9%), and angular cheilitis (57.97%). Overall the knowledge of Syrian dental students regarding the oral manifestations of systemic diseases was classified as intermediate, with relatively strong awareness in areas such as inflammatory bowel diseases and glossitis but significant gaps in understanding viral infections and hepatitis-related symptoms. Additionally, only 11.1% of students reported having diagnosed a systemic disease based on oral manifestations, indicating a limited application of this knowledge in clinical practice. There is a need to enhance and elevate the knowledge of dental students and practitioners regarding oral lesions in general, and the oral lesions of systemic background in particular.

BACKGROUND: Alcoholism adversely affects oral health, leading to issues such as dental caries, gingivitis, and oropharyngeal cancers. One notable oral effect is glossitis, which manifested as tongue inflammation. Chronic alcohol consumption can lead to sialadenosis, disrupting salivary gland function. AIM: This study aimed to demonstrate how alcohol intoxication induces histopathological and ultrastructural degenerative alterations in the tongue and parotid tissues of experimental rats and the therapeutic potential of 10-dehydrogingerdione (10-DHGD). METHODS: A total of 40 albino male rats were categorized equally into four groups for the purpose of investigation. The control group received no medication. For 45 days, the alcohol-treated group was given ethyl alcohol daily orally at a rate of 3.7 g/kg body weight; 10-DHGD-treated group was given a daily orally dosage of 10 mg/kg of freshly prepared extract; and the last group was administered a combination of alcohol and 10-DHGD. Histopathological analysis was performed in all the groups, while Ki-67 was used as an immunohistochemical investigation for any nuclear proliferative activity. Additionally, a transmission electron microscope (TEM) ultrastructural assessment was carried out. RESULTS: The alcohol-treated group displayed destructive alterations in their tongue and parotid tissues. 10-DHGD intake in combination with alcohol ameliorated such alterations to a certain extent. When comparing the alcohol-treated group’s tissues to those of the other groups under inquiry, an immunohistochemical analysis showed a highly significant decrease in Ki-67 expression. In addition, TEM examination of alcohol examined groups revealed fragmented myofibrils of the muscle of the tongue with dilated RER and swollen mitochondria in both the tongue and parotid samples, which were minimized by concomitant 10-DHGD ingestion. CONCLUSION: Long-term alcohol intake provoked intoxication in oral tissues, and 10-DHGD treatment dramatically ameliorated these deteriorating consequences.