Oral Manifestations of Systemic Disease

60 slides · PPTX & PDF available

Download PDF

Request PowerPoint

PowerPoint animations are preserved in the original file.

Slide index (60)

Loading slide titles…

Loading presentation…

Swipe on touchscreens · Use ← / → to change slides, Home / End to jump.

Lecture topics

Why oral lesions matter
Infectious mononucleosis: Throat findings
Infectious systemic diseases: Rapid differentiation
Pemphigoid: Overlapping oral appearance
Pancytopenia: Potential neck extension
Phenytoin: Fibrous gingival enlargement
Where to examine: Anatomic targets
What this source supports — and what it does not

Slide index & full transcript (60 slides)

Text from the original slides, in presentation order. Diagrams and images remain in the viewer above.

Slide 1 · Oral Manifestations

of Systemic Disease

A clinicopathologic approach to systemic disease presenting in the mouth

Infectious • Mucocutaneous • Hematologic • Other

Dr Abu Suraih Sakhri

MBBS, MD (Pathology)

www.abusuraihsakhri.com

Slide 2 · Learning objectives

Recognize characteristic oral patterns that suggest systemic disease.

Associate infectious, mucocutaneous, and hematologic disorders with their oral findings.

Distinguish lesions with similar appearances by location, evolution, and context.

Use oral findings to formulate — not prematurely confirm — a systemic differential.

Slide 3 · Why oral lesions matter

Visible mucosal change

Recognize a characteristic pattern

Consider systemic association

An oral lesion can be the first clue to an otherwise unsuspected systemic disorder.

Slide 4 · The four major disease groupings

Group

Examples in the source

Common oral signals

Infectious

Scarlet fever; measles; mononucleosis; diphtheria; HIV

Tongue change; enanthema; membrane; opportunistic lesions

Mucocutaneous

Lichen planus; pemphigus; pemphigoid; erythema multiforme

Lacy keratosis; vesicles; erosions

Hematologic

Pancytopenia; acute / monocytic leukemia

Infection; gingival infiltration

Other

Pigment syndromes; drugs; pregnancy; telangiectasia

Pigment; gingival mass/enlargement; vascular spots

Group

Examples in the source

Common oral signals

Slide 5 · Morphology is the first diagnostic language

Appearance

Description

Important source associations

White / red tongue

Papillary prominence ± white coating

Scarlet fever

Spotty enanthema

Small mucosal spots

Measles

Lacy white keratosis

Reticulate mucosal network

Lichen planus

Vesicles → erosion

Ruptured fragile blisters

Pemphigus; pemphigoid

Pigmentation

Melanotic oral discoloration

Addison; hemochromatosis; others

Appearance

Description

Important source associations

Slide 6 · Infection-associated findings

Acute exanthem / throat illness

Immune dysfunction

Scarlet fever: Striking tongue changes

Measles: Koplik spots; Enanthema

Mononucleosis: Pharyngitis; Petechiae

Diphtheria: Tough fibrinosuppurative membrane

HIV: Opportunistic oral infection

Hairy leukoplakia may signal immunosuppression

Kaposi sarcoma may affect oral tissues

Slide 7 · Scarlet fever: Altered tongue papillae

Conceptual schematic — not a clinical image

Recognition and interpretation

Fiery red tongue with prominent papillae is described as a raspberry tongue.

A white-coated tongue with projecting hyperemic papillae is called a strawberry tongue.

The conspicuous papillae provide the principal visual clue.

Slide 8 · Raspberry tongue versus strawberry tongue

Raspberry tongue

Strawberry tongue

Fiery red tongue

Papillae become visually prominent

No white coating required by the definition

White-coated dorsum

Hyperemic papillae project through coating

Two appearances associated with scarlet fever

Slide 9 · Measles: Koplik spots

Conceptual schematic — not a clinical image

Recognition and interpretation

Spotty oral enanthema can precede the cutaneous eruption.

Koplik spots are described as buccal mucosal ulcerations near Stensen duct.

Anatomic localization helps distinguish this finding from diffuse oral lesions.

Slide 10 · Measles: Oral findings can precede skin signs

Oral enanthema

Recognize buccal Koplik spots

Skin rash may follow

The oral examination can contribute to early syndromic recognition.

Slide 11 · Infectious mononucleosis: Throat findings

Acute pharyngitis and tonsillitis are characteristic listed associations.

Tonsils may be coated by a gray-white exudative membrane.

The oral examination should be integrated with the neck-node findings.

Slide 12 · Mononucleosis: Anatomic pattern

Oropharynx

Additional clues

Acute pharyngitis

Exudative tonsillar coating

Gray-white membrane appearance

Palatal petechiae

Enlarged cervical lymph nodes

Combined findings strengthen syndromic suspicion

Slide 13 · Diphtheria: Tough inflammatory membrane

Conceptual schematic — not a clinical image

Recognition and interpretation

The source describes a dirty-white membrane over the tonsils and retropharynx.

The membrane is tough and fibrinosuppurative.

It is a different descriptive pattern from small mucosal spots or lacy lesions.

Slide 14 · Exudates and membranes: Three different contexts

Condition

Source-described oral finding

Discriminating context

Infectious mononucleosis

Gray-white tonsillar exudative coating

Pharyngitis; cervical nodes; palatal petechiae

Diphtheria

Tough, dirty-white tonsillar/retropharyngeal membrane

Characteristic membrane appearance

Oral candidiasis

Gray-white superficial pseudomembrane

Can be scraped off; erythematous base

Condition

Source-described oral finding

Discriminating context

Slide 15 · HIV: Why the oral spectrum is broad

The source links HIV to susceptibility to opportunistic oral infections.

Herpesvirus infections and candidiasis are specifically emphasized.

Oral tumors and EBV-associated epithelial change form additional patterns.

Slide 16 · HIV: Opportunistic oral infections

Infectious lesions listed

Pathologic interpretation

Herpesvirus-associated oral lesions

Candida infections

Other fungal infections

The oral findings may reflect altered immune defense.

No single opportunistic lesion uniquely establishes HIV.

Clinical and laboratory correlation remains necessary.

Slide 17 · Hairy leukoplakia in the systemic-disease context

Conceptual schematic — not a clinical image

Recognition and interpretation

EBV-associated lesion classically affects the lateral border of the tongue.

Confluent white hyperkeratotic patches have a fluffy or hairy surface.

Unlike thrush, the lesion cannot be scraped off.

Slide 18 · Hairy leukoplakia versus oral thrush

Hairy leukoplakia

Pseudomembranous candidiasis

Typically lateral tongue

White, fluffy, hyperkeratotic thickening

Cannot be scraped off

EBV association; Immunocompromise

Superficial gray-white membrane

Scrapable; Erythematous base exposed

Candida infection

Can accompany immunosuppression

Slide 19 · Infectious systemic diseases: Rapid differentiation

Disease

Oral clue

Additional context

Scarlet fever

Raspberry / strawberry tongue

Papillary prominence

Measles

Koplik spots

Buccal site; enanthema before rash

Mononucleosis

Exudative pharyngotonsillitis

Palatal petechiae; neck nodes

Diphtheria

Tough dirty-white membrane

Tonsillar and retropharyngeal location

HIV-associated disease

Opportunistic infection / other oral lesions

Candida; herpesvirus; Kaposi; EBV

Disease

Oral clue

Additional context

Slide 20 · Case reasoning: Febrile oral enanthema

Teaching vignette

A patient with an acute febrile exanthem has small mucosal abnormalities around a parotid duct opening, noted before the skin eruption.

Pattern-based interpretation

Temporal clue: Oral lesion before rash.

Localization: Buccal mucosa at Stensen duct.

Lesion pattern: Localized spots / ulcerations.

Measles-associated Koplik spots

Slide 21 · Mucocutaneous diseases: Three dominant patterns

White keratotic change

Blistering or erosive change

Lichen planus: Reticular white lines

Some lesions become erosive

May accompany skin disease

Pemphigus: Rupture-prone bullae

Pemphigoid: Similar clinical lesions

Erythema multiforme: Vesiculobullous eruption

Slide 22 · Oral lichen planus: Reticular keratosis

Conceptual schematic — not a clinical image

Recognition and interpretation

Reticulate, lacelike white lesions are the classic oral pattern.

The keratotic lines may coexist with ulceration.

A minority of cases have bullous change in the source description.

Slide 23 · Lichen planus: Reticular versus erosive change

Reticular predominant

Erosive / ulcerated change

Lacelike network of white keratotic lines

White appearance dominates inspection

A morphologic pattern, not a standalone diagnosis

Mucosal surface may ulcerate

Symptoms or appearance may shift with erosions

Consider the broader clinical context

Slide 24 · Skin–mouth relationship in lichen planus

Oral lesions are reported in more than half of patients with cutaneous lichen planus.

The textbook characterizes isolated oral involvement as uncommon.

A skin history can therefore help contextualize the oral morphology.

Slide 25 · Pemphigus: Fragile vesicles and bullae

Conceptual schematic — not a clinical image

Recognition and interpretation

The source emphasizes mucosal vesicles and bullae that rupture readily.

Rupture leaves hyperemic erosions covered by exudate.

The observed mouth lesion may therefore be an erosion rather than an intact blister.

Slide 26 · Pemphigus: Lesion evolution

Vesicle or bulla

Fragile blister ruptures

Exudate-covered red erosion

Morphologic evolution explains why persistent erosions can dominate the oral examination.

Slide 27 · Pemphigoid: Overlapping oral appearance

Oral lesions in mucous membrane pemphigoid as resembling pemphigus.

Clinical appearance alone may not distinguish the two disorders.

Histologic distinction is emphasized.

Slide 28 · Pemphigus and pemphigoid: What can be concluded?

Feature

Pemphigus

Mucous membrane pemphigoid

Clinical oral lesions

Fragile vesicles / bullae; erosions

Can resemble pemphigus

Morphology as a discriminator

Insufficient alone

Histology

Differentiation required

Limitation of source extract

No cleavage-plane details

Feature

Pemphigus

Mucous membrane pemphigoid

Slide 29 · Erythema multiforme: Mucocutaneous eruption

The source describes a maculopapular, vesiculobullous eruption.

Reported contexts include a preceding infection and drug ingestion.

Cancer and collagen vascular disease are additional listed associations.

Oral assessment should be interpreted alongside the skin involvement.

Slide 30 · Extensive mucocutaneous reactions

Source language

Clinical inference

Widespread mucosal and skin involvement to the Stevens–Johnson syndrome term.

This lecture does not use the short table entry to define current SJS classification.

Extensive, destructive mucosal involvement is a serious presentation.

Recognition and urgent clinical assessment take priority over labeling from appearance alone.

Slide 31 · White, bullous and erosive oral patterns

Lesion pattern

Primary association

Important qualification

Lacy white network

Lichen planus

Ulceration is possible

Rupture-prone blister → erosion

Pemphigus

Hyperemic base, exudate

Pemphigus-like oral disease

Mucous membrane pemphigoid

Histology needed to separate

Vesiculobullous mucocutaneous eruption

Erythema multiforme

Context and systemic distribution matter

Lesion pattern

Primary association

Important qualification

Slide 32 · Case reasoning: Lacelike oral plaques

Teaching vignette

A patient with known cutaneous lesions has intersecting white keratotic streaks in the oral mucosa; Superficial erosions are also noted.

Pattern-based interpretation

Dominant pattern: Reticular white keratosis.

Possible variant: Associated erosions.

Systemic clue: Cutaneous involvement.

Oral lichen planus pattern

Slide 33 · Hematologic disorders: Two mechanisms

Loss of effective host defense

Severe oral infection

Gingivitis; Pharyngitis; Tonsillitis

In the hematologic section, gingival enlargement has a different basis: Leukemic infiltration.

Slide 34 · Pancytopenia: Oral infection burden

Agranulocytosis and aplastic anemia are listed under pancytopenic disorders.

The source describes potentially severe gingivitis, pharyngitis, and tonsillitis.

The distribution may extend beyond the gingiva and oropharynx.

Slide 35 · Pancytopenia: Potential neck extension

Severe oral infection

Spread beyond oral structures

Neck cellulitis / Ludwig angina

The source explicitly identifies deep neck extension as a potentially serious consequence.

Slide 36 · Acute leukemia: Oral findings from host-defense loss

The source links acute leukemia to depletion of functioning neutrophils.

Oral lesions can resemble those described in pancytopenia.

Severe mucosal and oropharyngeal infections are therefore a principal association.

Slide 37 · Monocytic leukemia: Gingival infiltration

Conceptual schematic — not a clinical image

Recognition and interpretation

Leukemic infiltration can enlarge the gingivae.

Periodontitis frequently accompanies the infiltrative gingival change in the source description.

This is an enlargement pattern, distinct from the infection-dominant acute leukemia entry.

Slide 38 · Hematologic oral findings: Pathologic contrast

Disorder

Principal process

Oral consequence

Pancytopenia / agranulocytosis

Severe infection predisposition

Gingivitis; pharyngitis; tonsillitis

Acute leukemia

Loss of functioning neutrophils

Infections resembling pancytopenia

Monocytic leukemia

Leukemic tissue infiltration

Enlarged gingivae; periodontitis

Disorder

Principal process

Oral consequence

Slide 39 · Case reasoning: Enlarged gingiva in leukemia

Teaching vignette

A patient with a suspected hematologic disorder develops prominent gingival enlargement and concomitant periodontal inflammatory change.

Pattern-based interpretation

Finding: Enlargement, not just ulceration.

Source association: Leukemic infiltration.

Accompanying finding: Periodontitis.

Consider monocytic leukemia

Slide 40 · Other systemic or physiologic associations

Pigment and vascular findings

Gingival proliferations

Melanotic mucosal pigmentation: Several systemic diseases

Telangiectasias: Rendu–Osler–Weber syndrome

Phenytoin: Fibrous gingival enlargement

Pregnancy: Gingival pyogenic granuloma

Slide 41 · Melanotic oral pigmentation: A systemic clue

Conceptual schematic — not a clinical image

Recognition and interpretation

The source lists several unrelated diseases with melanotic oral pigmentation.

Pigmentation by itself is not specific for any one listed condition.

Associated history and findings determine the differential.

Slide 42 · Melanotic pigmentation: Source-listed causes

Systemic association

Oral manifestation

Other detail actually stated

Addison disease

Melanotic pigmentation

None in this oral table

Hemochromatosis

Melanotic pigmentation

None in this oral table

Fibrous dysplasia (Albright syndrome)

Melanotic pigmentation

Bone disorder name

Peutz–Jeghers syndrome

Melanotic pigmentation

Gastrointestinal polyposis

Systemic association

Oral manifestation

Other detail actually stated

Slide 43 · Phenytoin: Fibrous gingival enlargement

Conceptual schematic — not a clinical image

Recognition and interpretation

The listed drug association is phenytoin ingestion.

The characteristic oral change is striking fibrous enlargement of gingivae.

Medication history is essential when interpreting this lesion type.

Slide 44 · Pregnancy-associated pyogenic granuloma

Conceptual schematic — not a clinical image

Recognition and interpretation

The source describes a pyogenic granuloma projecting from the gingiva.

It is labeled a pregnancy tumor in the oral-manifestations table.

A focal gingival mass differs morphologically from diffuse fibrous enlargement.

Slide 45 · Hereditary hemorrhagic telangiectasia

Conceptual schematic — not a clinical image

Recognition and interpretation

Rendu–Osler–Weber syndrome is described as an autosomal dominant disorder.

Multiple congenital telangiectasias occur beneath the oral and labial mucosa.

The vascular pattern is distinct from melanotic pigmentation.

Slide 46 · Gingival enlargement and masses: Differential

Context

Structural oral change

Dominant clue

Monocytic leukemia

Leukemic gingival infiltration

Enlargement plus periodontitis

Phenytoin ingestion

Fibrous gingival enlargement

Medication exposure

Pregnancy

Protruding pyogenic granuloma

Focal gingival mass

Context

Structural oral change

Dominant clue

Slide 47 · Pigment versus vascular change

Observed feature

Source association

Reasoning limitation

Melanotic pigmentation

Addison / hemochromatosis / Albright / Peutz–Jeghers

Pigment alone does not establish which disease

Multiple telangiectasias

Rendu–Osler–Weber syndrome

Inspect mucosal and lip sites

Gingival mass / enlargement

Pregnancy, phenytoin, leukemia

Assess morphology and context

Observed feature

Source association

Reasoning limitation

Slide 48 · White oral lesions require pattern discrimination

Syndrome-associated white findings

In immunosuppression

Mononucleosis: Tonsillar exudate

Diphtheria: Tough membrane

Lichen planus: Lacy keratotic network

Thrush: Scrapable white membrane

Hairy leukoplakia: Nonscrapable lateral tongue lesion

Do not equate all white oral lesions with one diagnosis

Slide 49 · Oral erosions: The preceding event matters

Primary erosive / bullous patterns

Other oral inflammatory patterns

Pemphigus: Rupture-prone vesicles

Pemphigoid: Clinically similar lesions

Erythema multiforme: Mucocutaneous eruption

Lichen planus: Possible ulceration

Diphtheria: Membrane, not a classic bulla

Measles: Focal buccal abnormalities

Slide 50 · History directs the systemic differential

History domain

Examples suggested by source

Oral findings to inspect

Acute febrile illness

Scarlet fever, measles, mononucleosis

Tongue, buccal mucosa, tonsils

Skin or mucosal disease

Lichen planus, pemphigus, pemphigoid

Reticulation, bullae, erosions

Immune / blood disorder

HIV, pancytopenia, leukemia

Infection, white plaques, gingiva

Medication / pregnancy

Phenytoin, pregnancy

Gingival enlargement or focal mass

Inherited / systemic disorder

Pigment syndromes, HHT

Pigment or telangiectasias

History domain

Examples suggested by source

Oral findings to inspect

Slide 51 · Where to examine: Anatomic targets

Oral site

Characteristic lesions in the source

Dorsal tongue

Raspberry / strawberry tongue

Buccal mucosa near Stensen duct

Measles Koplik spots

Palate

Mononucleosis-related petechiae

Tonsils and retropharynx

Exudate or tough membrane

Lateral border of tongue

EBV-associated hairy leukoplakia

Gingiva

Infections, infiltration, hyperplasia, pregnancy mass

Oral site

A tough tonsillar/retropharyngeal membrane deserves prompt clinical assessment.

Extensive ulceration with concurrent skin disease requires broader mucocutaneous evaluation.

Severe gingival or pharyngeal infection in a cytopenic patient may spread to the neck.

Marked unexplained gingival enlargement can reflect systemic hematologic disease.

Slide 58 · High-yield pattern-to-systemic association map

Oral phenotype

Priority source-linked associations

Red papillary tongue / white coating

Scarlet fever

Koplik spots / spotty enanthema

Measles

Exudative pharyngitis with palatal petechiae

Infectious mononucleosis

Lacelike keratosis, with or without erosion

Lichen planus

Fragile bullae / erosions

Pemphigus; pemphigoid

Severe oral infections or gingival infiltration

Cytopenia; leukemia

Pigmentation, gingival mass, telangiectasias

Endocrine / hereditary / drug / pregnancy associations

Oral phenotype

Priority source-linked associations

Slide 59 · What this source supports — and what it does not

Established from the provided text

Not established by this excerpt

Named disease–oral manifestation pairs

Certain characteristic anatomic locations

Some clinical morphology and associations

Potential neck spread in severe oral infection

Sensitivity, specificity, or disease prevalence

Detailed immunofluorescence or histologic criteria

Formal testing or management algorithms

Current SJS/TEN nosology or staging thresholds

Slide 60 · References and source limits

Textbook: Robbins, Cotran & Kumar, Pathologic Basis of Disease, 11th edition (2026).

Principal material: the table “Oral Manifestations of Some Systemic Diseases” and accompanying narrative.

Context: adjacent oral candidiasis and hairy leukoplakia discussions.

The original chapter PDF and licensed diagnostic photographs were not supplied; all schematics are conceptual, not clinical evidence.