Recurring oral erythema multiforme-like lesions elicited by COVID-19 infection: a case report

Abstract

Oral mucosa could be the first site infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) –the
causative agent of coronavirus disease 2019 (COVID-19). Indeed, different oral and paraoral lesions, conditions
and symptoms have been reported in patients with COVID-19. Experts thought that such oral lesions could be
secondary to the COVID-19-associated deterioration of systemic health or due to treatments of COVID-19. We
present here a case of a 24-year-old male presented with painful multiple ulcers involving the labial and buccal
mucosae bilaterally after a while of feeling very mild symptoms that laboratory-confirmed by reverse-transcription
polymerase chain reaction to be COVID-19. Involvement of eyes was also reported. The above clinical presentation
was consistent with minor erythema multiform. Many topical preparations were prescribed but with limited
improvement. Hence, oral prednisolone was prescribed with a 40-mg loading dose that was tapered by 10 mg
every 3 days. Complete healing of oral mucosa was observed on the 10 day. Strikingly, the patient got affected
with the second episode of similar oral lesions 5 months later without any apparent triggering factors, suggestive
a long term effects of COVID-19 in a subset of patients. The present case report provides dentists with useful
information and increases their awareness regarding possible involvement of oral cavity with multiple ulcerative
lesions associated with COVID-19.

KEYWORDS
Oral erythema multiforme; Oral manifestations; COVID-19; Case report.