MULTIFORME EXUDATIVE ERYTHEMA AS A MANIFESTATION OF IMMUNE STRESS SYNDROME: A CLINICAL CASE

Anatoliy  Nikolishin; Nataliya  Kotelevska; Ella  Nikolishyna

doi:10.21272/eumj.2025;13(2):575-583

Anatoliy Nikolishin Poltava State Medical University Poltava, Ukraine https://orcid.org/0000-0002-4395-7828
Nataliya Kotelevska Poltava State Medical University Poltava, Ukraine https://orcid.org/0000-0002-7095-653X
Ella Nikolishyna Poltava State Medical University, Poltava, Ukraine https://orcid.org/0000-0001-7345-4183

DOI: https://doi.org/10.21272/eumj.2025;13(2):575-583

Keywords: oral mucosa, immune response, diagnostics, autoinfection, stomatitis

Abstract

Introduction. Immune stress syndrome, as a manifestation of autoinfectious diseases of the oral mucosa, develops under the influence of general and local factors that can affect the tolerance of the mucosa. Violation of the barrier function of the epithelium causes inflammatory autoinfectious diseases of the oral cavity. The cause of autoinfection is the disruption of local tolerance to microorganisms of normal flora and their simultaneous activation. Potential trigger factors are necessary to start the immunological reaction of the oral mucosa. These are hypothermia, prolonged dental manipulations and other stress factors. The aim of the work is to familiarize doctors with the difficulties in diagnosing and treating immune stress syndrome, which is associated with dental manipulations.

Materials and methods. The article demonstrates the patient's own clinical observation and the complexity of the course of erythema multiforme exudative as a manifestation of immune stress syndrome.

Results and discussion. According to the results of a general blood test, blood test for IgG and IgM to herpes virus antigens type 1, 2, bacterioscopy of scrapings from the affected areas, the diagnosis of «Stevens-Johnson syndrome with predominant damage to the oral mucosa and red border of the lips» was established and complex treatment was prescribed (detoxification, anti-inflammatory, immunotherapy). Therefore, dentists need to remember about the possibility of provoking complications after long-term dental interventions. It is imperative to conduct a clinical and laboratory examination, which allows not only to verify the diagnosis, but also to substantiate an effective treatment and prevention protocol.

Conclusions. The authors of the article, to prevent the occurrence of the manifestation of «immune stress syndrome» in patients with a burdened psychosomatic status, proposed an algorithm for the doctor's actions when planning dental interventions and preventive measures that the patient should perform («Landmark for the patient»).

Downloads

Download data is not yet available.

References

Schifter M, Yeoh SC, Coleman H, Georgiou A. Oral mucosal diseases: the inflammatory dermatoses. Aust Dent J. 2010 Jun;55 Suppl 1:23-38. PMID: 20553242. https://doi.org/10.1111/j.1834-7819.2010.01196.x

Skrypnikova TP, Marchenko AV, Khmil TA, Tymoshchenko YuV, Khavalkina LM. Shkala prohnozuvannya zahostrennya khronichnoho herpetychnoho hinhivostomatytu pislya tryvalykh stomatolohichnykh manipulyatsiy. [The scale for predicting exacerbation of chronic herpetic gingivostomatitis after long-term dental manipulations: scientific work]. Ukraine, certificate of copyright registration for the work, No. 117136. Date of registration 03/15/2023. https://repository.pdmu.edu.ua/items/ae64c2eb-08dc-4804-b113-23d19a9ed9ad. (Ukrainian).

Skrypnikova TP, Pavlenko LG, Senchakovich YuV. Tablytsya “Diahnostyka ta prohnozuvannya proyaviv khronichnoho retsydyvuyuchoho herpesu – «syndromu napruhy» u patsiyentiv pry stomatolohichnykh manipulyatsiyakh». [Table «Diagnosis and prediction of manifestations of chronic recurrent herpes – «tension syndrome» in patients during dental manipulations»: scientific work]. Ukraine, certificate of copyright registration for the work, No. 23240, registration date of 12/24/2007. (Ukrainian).

Pelaez-Prestel HF, Sanchez-TrincadoJL, Lafuente EM, Reche EM. Immune Tolerance in the Oral Mucosa. Int. J. Mol. Sci. 2021, 22(22), 12149. https://doi.org/10.3390/ijms222212149

Hasiuk NV, Yeroshenko GA, Maystruk PO. Features of the cell complex of the mortal shell of the rope cavity on the field of tolerancy. World of Medicine and Biology. 2018; 4(66): 157-160. (Ukrainian). https://doi.org/10.26724/2079-8334-2018-4-66-157-160

Huang X, Huang X, Huang Y, Zheng J, Lu Y, Mai Z, Zhao X, Cui L, Huang S. The oral microbiome in autoimmune diseases: friend or foe? J Transl. Med. 2023; 21: 211-24. https://doi.org/10.1186/s12967-023-03995-x

Dubinin S, Zaitsev A, Vatsenko A, Ulanovskaya-Tsyba N, Perederii N, Boichenko О. Mezhmikrobnyye vzaimodeystviya oral'nogo biotopa. [Intermicrobial interactions of the oral biotope]. Georgian Medical News. 2020; 299: 131-7. https://repository.pdmu.edu.ua/items/c176a4bc-e52e-40c5-93cb-d1aa9f6e889d.

Dobrovolska OV, Hasiuk NV, Klytynska OV, Zaliznyak MS, Antonyshyn IV, Pogoretska KV, Patskan LA. State characteristics of the problem of oral cavity environmental system. Wiad. Lek. 2020; 73(5): 1037-40. https://doi.org/10.36740/wlek202005137

Kitamoto S, Nagao-Kitamoto H, Hein R, Schmidt TM, Kamada N. The Bacterial Connection between the Oral Cavity and the Gut Diseases. Journal of Dental Research. 2020;99(9):1021-1029. https://doi.org/10.1177/0022034520924633

Rath S, Bal SCB, Dubey D. Oral Biofilm: Development Mechanism, Multidrug Resistance, and Their Effective Management with Novel Techniques. Rambam Maimonides Med J. 2021 Jan 19;12(1):e0004. PMID: 33478627; PMCID: PMC7835112. https://doi.org/10.5041/RMMJ.10428

Petrushanko TA, Tchereda VV, Loban GA. The relationship between colonization resistance of the oral cavity and individual-typological characteristics of personality: dental aspects. Wiad. Lek. 2017; LXX (4): 754-757. https://repository.pdmu.edu.ua/items/f3a727a5-03f0-4674-ae71-ec5e8a0ec0af.

Kumar NN, Panchaksharappa MG, Annigeri RG. Psychosomatic disorders. An overview for oral physician. Journal of Indian Academy of Oral Medicine and Radiology. 2016; 28 (1): 24-29. https://doi.org/10.4103/0972-1363.189979

Loban’ G, Faustova M, Dobrovolska O. et al. War in Ukraine: incursion of antimicrobial resistance. Ir J Med Sci. 2023; 192: 2905–2907. https://doi.org/10.1007/s11845-023-03401-x

Dvornyk V, Lytovchenko I, Popovych I, Holovanova I, Dvornyk I, Muravlova O, Yerus L, Teslenko O. Proteznyy stomatyt u patsiyentiv z tsukrovym diabetom: korektsiya psykhoemotsiynoho napruzhennya. [Prosthetic stomatitis in patients with diabetes mellitus: correction of psycho-emotional stress]. Med. perspek. [Internet]. 2023 Jun.30 [cited 2024 Sept.28]; 28(2): 127-35. (Ukrainian). https://doi.org/10.26641/2307-0404.2023.2.283362

Baybekov O, Stanishevskiy Y, Sachivkina N, Bobunova A, Zhabo N, Avdonina M. Isolation of Clinical Microbial Isolates during Orthodontic Aligner Therapy and Their Ability to Form Biofilm. Dent J (Basel). 2023 Jan 3;11(1):13. PMID: 36661550; PMCID: PMC9858208. https://doi.org/10.3390/dj11010013

Khachatryan G, Markaryan M, Vardanyan I, Manrikyan M, Manrikyan G. Morphological Characteristics and Prevention of Tooth Enamel Demineralization during Orthodontic Treatment with Non-Removable Appliances. Int. J. Environ. Res. Public Health. 2023; 20(1): 540. https://doi.org/10.3390/ijerph20010540

Stepanenko VV, Chebotar AI, Bondar SO et al. Dermatolohiya ta venerolohiya: pidruchnyk. [Dermatology and venereology : textbook]. 2nd, repr. Kyiv: VSV "Medicine" Publ., 2020. pp. 62-5, 80-7. ISBN: 978-617-505-811-4. (Ukrainian).

Rozhko MM, Kyrylenko II, Denysenko OH. et al. Stomatolohiya : pidruchnyk (VNZ III‒IV r.a.). [Stomatology: in 2 books. Book 2: textbook (University ІІІ-IV a.l.)]. Rozhko MM, edited. 2nd, repr. Kyiv: VSV "Medicine" Publ., 2018. pp. 501-6. ISBN: 978-617-505-681-3. (Ukrainian).

Latsch K, Girschick HJ, Abele-Horn M. Stevens-Johnson syndrome without skin lesions. J Med Microbiol. 2007 Dec;56(Pt 12):1696-1699. PMID: 18033843. https://doi.org/10.1099/jmm.0.47331-0

Skrypnikov PM, Ishcheykin KE, Kaidashev IP, Bilokin SO, Pavlenko LL, Khmil TA, Senchakovych YuV. Urazhennya shkiry oblychchya ta slyzovoyi obolonky porozhnyny rota virusom prostoho herpesu I typu (klinichni proyavy, diahnostyka, metody likuvannya, profilaktyka). [Damage to the skin of the face and mucous membrane of the oral cavity by herpes simplex virus type I (clinical manifestations, diagnosis, methods of treatment, prevention)]. Poltava: Company АСМІ Publ, 2013. 84 p. (Ukrainian).

Nikolishin AK, editor. Terapevtychna stomatolohiya: pidruchnyk. [Therapeutic dentistry: a textbook for students of stomatological faculties of higher medical educational institutions of IV levels of accreditation]. 2nd, rev., enl. Vinnytsia: New Book Publ., 2012. 680 p. ISBN: 978-966-382-312-6. (Ukrainian).

59 Heneralna asambleya VMA. Helsinska deklaratsiya Vsesvitnyoyi medychnoyi asotsiatsiyi «Etychni pryntsypy medychnykh doslidzhen za uchastyu lyudyny u yakosti obyekta doslidzhennya» 6-y perehlyad. Morfolohiya. 2010;4(2):65-8. http://nbuv.gov.ua/UJRN/Morphology_2010_4_2_10, http://zakon4.rada.gov.ua/laws/show/990_005. (Ukrainian).

Hasiuk N, Bozhyk S, Radchuk V. Modern view on mechanisms of epithelium differentiation of the oral mucosa in normal and pathological processes. Acta stom. Naissi. 2021; 84(37): 2314-24. https://doi.org/10.5937/asn2184314h

Skrypnikova T, Skrypnykov P, Gancho O, Loban G, Tymoshenko J, Fedorchenko V, Pysarenko O, Lazareva K, Khmil T, Kulai O. Improvement of the methodology of biomaterial collection for the diagnosis of the oral cavity mucosa diseases. Georgian Med News. 2024 Mar;(348):105-108. PMID: 38807402. https://pubmed.ncbi.nlm.nih.gov/38807402/