1 - Serviço de Imunoalergologia, Centro Hospitalar Universitário de Lisboa Central
2 - Serviço de Reumatologia Pediátrica, Centro Hospitalar Universitário de Lisboa Central
3 - Serviço de Gastrenterologia Pediátrica, Centro Hospitalar Universitário de Lisboa Central
- PAAM Digital 2021, publicação sob forma de resumo
Resumo:
Introdução: Allergic contact stomatitis (ACS) is an inflammatory disease caused by a T cell-mediated hypersensitivity reaction against allergens that contact the oral mucosa. Painful aphthous lesions usually appear 12-72 hours after the contact with the allergen and treatment is based on its avoidance. We present the rare case of an ACS to eggs.
Relato de caso: A 13-year-old boy reported recurrent episodes of painful ulcers of the oral mucosa with a negative impact on his feeding and communication since he was 11 years old. Lesions resolve within 1-2 weeks, with no residual lesion. He denied fever, genital or eye lesions, and systemic complaints. He was evaluated by a Gastroenterology and Rheumatology specialists, and the diagnosis of an inflammatory bowel disease or Behcet's disease were considered. Upper digestive endoscopy, colonoscopy, abdominal ultrasound, and directed laboratory evaluation were unremarkable. He was started on treatment with colchicine, with no improvement. Later, the patient noticed that lesions appeared 6-48 hours after ingestion of eggs and, less consistently, after ingestion of tomatoes, wheat and cow's milk. In this context, he was evaluated on an Allergy and Clinical Immunology appointment. Skin prick tests with commercial extract of egg white and egg yolk, cow's milk and wheat were negative. Patch skin tests with cow's milk, wheat bread, egg white and egg yolk, and tomato were negative at the 48 hours reading. However, at the 72 hours reading, a slight erythema and papulation were observed on the sites corresponding to egg white and egg yolk. The diagnostic of ACS to eggs was admitted, and the patient was instructed to avoid eggs, with resolution of the episodes. Later, he reported reappearance of the lesions upon reingestion of eggs.
Conclusões: The differential diagnosis of recurrent aphthous lesions is wide. The medical history and the absence of alterations in laboratory study allowed the exclusion of autoimmune diseases, hematological diseases, syndromes associated with fever, nutritional deficiencies, and local trauma. In this case, the association of egg ingestion with the development of painful, non-immediate aphthous lesions, the positive result of patch test with egg white and egg yolk at the 72 hours reading, and the non-recurrence of lesions during the egg eviction diet with its reappearance after egg reintroduction, support the definitive diagnosis of ACS to eggs.
Palavras Chave: Food allergy, egg, contact stomatitis