A 60-Year-Old Woman With Tongue Intractable Erosion

Paraneoplastic autoimmune multiorgan syndrome (PAMS), is a rare autoimmune disease with polymorphic mucocutaneous features and multi-organ involvement. Here, we report a 60-year-old woman presented with recurrent ulceration of the oral mucosa for half a year, and ulceration on the vulva mucosa. Firstly, she was seen in a dermatology clinic, and thalidomide tablets and loratadine were given orally for 1 week, but no improvement was observed. When she came to dental clinic, the oral examination revealed extensive erosions and small whitish lesions on the tongue and both buccal mucosa, and hyperemia lesions in the vulva. The pathological diagnosis of right buccal mucosa ulcer was lichenoid lesions with mild dysplasia. After treatment with systemic steroids and hydroxychloroquine, the lesions of buccal mucosa and vulva were healed, but the lingua erosion just decrease little in size. We suggested her to undergo a general examination to rule out potential lesions. Immunoserological examinations showed a positive autoantibody against rat bladder epithelium. Then, Laboratory studies showed a serum tumor marker(interleukin-8) is 1268.0pg/mL. Colonic biopsy detected tubular villous adenoma of the colon with high-grade intraepithelial neoplasia. Finally, a diagnosis of PAMS was made. After the removal of colonic lesions and the use of glucocorticoids, the erosive surface of the mucosa on the lingual mucosa healed. This case report contributes to the knowledge of oral manifestation of PAMS, and avoid missed diagnoses and misdiagnoses. Early diagnosis is crucial to improve patients’ management and survival.