Nirmatrelvir/ritonavir-induced oral lichenoid mucositis: a case report

Introduction

Lichenoid Mucositis (LM) is a chronic T-cell immune-mediation disorder often characterized by the presence of inflammatory infiltrates present in the subepithelial mucosa. The exact etiology of LM remains unknown, however, medications, local irritants, autoimmunity, and others have been linked to the clinical presentation of LM.

Case Presentation

74-year-old female presented to the ECU School of Dental Medicine with a 6 cm x 2 cm flat erythroleukoplakia and focally ulcerated lesion on the right buccal mucosa and the right lateral border of the tongue. No other ulceration was present in the oral cavity at the examination time. The patient reported the presence of a “nodule” on the right buccal mucosa after the administration of Paxlovid for the treatment of a COVID-19 infection. The patient reported the lesion as mildly irritant. Medical history was significant for Type II DM, HTN, and a heart murmur. Other intraoral finding included chronic active periodontitis. An incisional biopsy confirmed the lesion as an inflammatory subepithelial disorder consistent with lichenoid mucositis.

Discussion and Conclusion

The clinical presentation and findings of this case show strong correlation to case reports of oral lichenoid mucositis following COVID-19 treatment. Literature suggests that the onset of the lesion is multifactorial, however, there are no reports of direct causation between oral lichenoid mucositis and the administration of Paxlovid. The case report highlights the need for better insight into oral manifestations following COVID-19 infection and treatment.