A case of Rapp-Hodgkin syndrome featuring prominent oral leukokeratosis linked to a TP63 gene variant

BACKGROUND: Rapp-Hodgkin syndrome (RHS) is a rare autosomal dominant disorder caused by TP63 gene mutations. This case warrants reporting due to the presence of significant limb malformations, extensive caries in the maxillary teeth, and congenital absence of multiple mandibular teeth, accompanied by remarkably widespread oral leukokeratosis. Its novelty lies in exploring the synergistic role of chronic local mechanical irritation acting upon the TP63 mutation-induced epithelial developmental defect in the pathogenesis of the widespread oral leukokeratosis, offering a new clinical perspective on the mechanism of such lesions. CASE PRESENTATION: The patient presented with extensive leukokeratosis on the bilateral buccal mucosa and tongue margins, accompanied by congenital absence of most mandibular teeth and extensive caries in the maxillary teeth. Physical examination revealed significant limb malformations, including bilateral absence of the index and middle fingers with flexion deformities of the thumbs. Histopathological examination of the left buccal mucosa biopsy showed mild epithelial thickening, normal basal cells, intact basement membrane, and no epithelial dysplasia. Genetic testing confirmed the diagnosis of RHS by identifying a heterozygous mutation in the TP63 gene (c.953G > A, p. Arg318His). Management involved multidisciplinary assessment and supportive care. CONCLUSIONS: This case expands the oral clinical spectrum of RHS. When patients present with such concurrent complex oral mucosal lesions and limb malformations, genetic syndromes should be considered, warranting a multidisciplinary assessment including genetic counseling. It highlights the importance of recognizing systemic genetic signs in the diagnosis and management of rare oral diseases.