A Case Of Periadenitis Mucosa Necrotica Recurrens With Esophageal Ulcer

Periadenitis Mucosa Necrotica Recurrens (PMNR) is a severe form of recurrent oral ulceration, characterized by deep mucosal involvement, slow healing, and significant pain. This case report describes a 45-year-old female with persistent PMNR and intermittent abdominal pain, ultimately diagnosed with PMNR and esophageal mucosal ulceration. This case highlights PMNR as a potential manifestation of gastrointestinal disorders and discusses effective diagnostic and therapeutic strategies. The patient presented with recurrent severe oral ulcers for three years and periumbilical pain for one year, worsening in the past three months. Oral examination revealed a 3×3 cm ulcer with fibrinous exudate, mild induration, and significant tenderness. Endoscopy identified a 1.5 cm esophageal ulcer with chronic gastritis. Treatment included topical triamcinolone acetonide, systemic Xi Huang Wan for immune modulation, and proton pump inhibitors for esophageal ulcer management. Symptoms significantly improved after two weeks, with no recurrence at one-month follow-up. PMNR is associated with immune dysfunction, impaired microcirculation, and potential systemic conditions, particularly gastrointestinal diseases. Possible links between PMNR and esophageal ulceration include immune dysregulation, gastric acid reflux, and systemic inflammation involving IL-6 and TNF-α. This case underscores the importance of interdisciplinary diagnosis and management for refractory PMNR, emphasizing the need for gastrointestinal evaluation in persistent cases. PMNR may indicate underlying systemic diseases such as gastrointestinal disorders. Comprehensive assessment, including endoscopy, is crucial for persistent cases. Combined local and systemic therapy, alongside interdisciplinary collaboration, may enhance treatment outcomes.