A 44-year-old male patient, a tailor by profession reported to the Department of Oral medicine and Radiology, Sri Ramachandra University, Chennai, Tamil Nadu, India, in April 2014 with a chief complaint of an ulcer on the surface of the tongue for past five years. History of present illness revealed that the patient was apparently well five years back when he noticed an ulcer on the dorsal surface of the tongue in the year 2008, which was small initially, subsided on its own in a few days, associated with pain and burning sensation and persisted for about a month and healed on its own. It was recurrent in nature and when it appeared subsequently it gradually increased in size and he underwent biopsy in 2008 whose reports were unavailable with the patient. He was prescribed a topical application of 0.1% triamcinolone acetonide for a period of 15 days after which he was symptom free for about three years. Patient gave a history of recurrence of the ulcer from about one year and an increase in size to attain the present size. The patient underwent a biopsy in December 2013, which was reported as "inflammatory non-malignant granulomatous ulcer of the oral mucosa. The presence of plasma cells argues to exclude the possibility of associated systemic Crohn's disease." He was then prescribed dexamethasone rinses and prednisolone 5 mg three times a day for 15 days but had no relief. He complained of inability to eat properly due to the presence of burning sensation along with the pain which appeared in the past two months.Patient had no relevant medical history, no known drug allergy and not under any prolonged medication. No history of previous hospitalization was present. He did not give any history of gastrointestinal disturbances, distress, cramps or loss of hair. He had no history of smoking, alcohol or any form of deleterious habits. On general clinical examination, patient had no signs of anaemia, cyanosis, clubbing, jaundice and pedal oedema. His vital signs were in normal range and on clinical examination of systems, no abnormal findings were observed.On temporomandibular joint examination, no abnormal findings were observed. No facial asymmetry was noted. On regional lymph node examination, a single submandibular lymph node was palpable on both sides.On intraoral inspection of the lesion, a single, well defined bright red erythematous plaque like area was evident in the left dorsal surface of the tongue, approximately measuring about 4 cm x 4 cm in dimension, extending from the midline to the left lateroventral surface of the tongue and 1 cm behind the tip of the tongue to approximately 2 cm in front of the base of the tongue. Surface appeared erythematous and mildly wrinkled with grayish white hyperkeratotic areas intermingled with the presence of irregularities on the anterior margin. Surrounding area was mildly erythematous. Lateral and ventral surfaces over the lesion had three erosions which were about 1 cm x 1 cm in size each. On palpation, all the inspectory findings of size, shape, site, margins and ext...
Lichen planus (LP) is considered to be a T-cell-mediated inflammatory disorder. Inflammation is considered to produce disturbances of lipid metabolism which may affect the myocardium. Increased P-Wave Dispersion (PWD) is demonstrated as an independent risk factor for developing atrial fibrillation (AF). Hence the present study has been conducted to explore the possible relationship of oral lichen planus (OLP) with AF by the evaluation of PWD. Twelve-lead electrocardiographs (ECG) were obtained from 45 OLP patients and 45 age and gender-matched healthy controls. The P-wave durations (Pmax and Pmin) were calculated in all 12 leads. The difference between Pmax and Pmin was defined as P-Wave Dispersion (PWD). After the PWD was recorded, the results were statistically analyzed. The study showed that PWD increased on surface ECG measurements in OLP patients who were otherwise asymptomatic in relation to cardiac conditions. The p value obtained was <0.001 which was highly significant. The present study suggests a highly statistically significant association of OLP with increased P-wave dispersion. Hence the patients with OLP should undergo cardiac evaluation and follow up for early detection of atrial fibrillation.
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