Severe uremic stomatitis in a patient with untreated chronic renal failure

A 36-year-old female patient with chronic renal failure was referred by the internal medicine department for severe and painful oral lesions extending to the nasal mucosa. The patient&acute;s medical record revealed that she did not receive dialysis during the last 2 months. Oral examination revealed white hyperkeratotic lesions of the tongue together with a diffuse erythema covered with thick whitish-yellow pseudo membrane. An ulcerated, painful lesion of 3 cm in size was present in the hard palate. Similar lesions were present in the nostrils, especially on the right side. Painful plaques and crusts were also present in both lips. The patient reported severe burning sensation, xerostomia, and halitosis. She was also suffering from loss of appetite, nausea, and dysphagia. Severe weight loss was also noted. Laboratory tests revealed elevated serum creatinine: 711umol/l ( normal 40-115umol), uremia: 32.8mmol/l (normal 2.8-7.2mmol/l), and uric acid 889umol/l (normal 180-420 umol). Protein C reactive was also elevated with 42 mg/l normal <8 mg/l). Treatment consisted in improving urea blood concentration and the underlying renal failure. The patient was also asked to improve her oral hygiene using antiseptic mouthwashes (chlorhexidine digluconate 0.12%) and antifungal agents (fungizone).