Case Series: Angiotensin Receptor Blocker-Associated Oral Lichenoid Lesion

Angiotensin II receptor blocker (ARB) was reported to be associated with oral lichenoid lesion (OLL), however, its clinical and histopathological manifestations need to be further described. To analyze the clinical and histopathological manifestations of suspicious OLL patients using ARB drugs and discover their potential characters. A retrospective case series of patients using ARB drugs diagnosed with OLL between 2021–2022 (n=16) was conducted. Demographic data, systemic medical history, ARB type, concomitant medications, and histopathological images of mucosa were collected. Descriptive statistics were used for data summarization. The median patient age was 54.6±10.6 years (50% male) with all patients using ARB drugs for hypertension, and 43.75% only used ARB drugs before oral manifestation while 31.25% used at least two cardiovascular drugs including ARB. Clinical manifestation showed 81.25% lesions were symmetrical and reticular lesion of the buccal mucosa was most frequent. Histopathology diagnose indicated 10 OLL, 2 oral lichen planus (OLP), 2 oral leukoplakia (OLK) and 2 uncertain diagnoses, and especially, we observed plasma cell infiltration in 11 specimens, perivascular inflammation and diffuse distribution of lymphocytic infiltration throughout the lamina propria in OLL specimens, which differ from the typical histopathological features of OLP. Although this study is limited by sample size and retrospective design bias, it indicates that ARB-associated OLL may have similar clinical manifestations but different histopathological manifestations with OLP. We recommend histopathologic examination to establish the diagnosis of ARB-related OLL and guide treatment.