Oral Manifestations of Coronavirus Disease 2019 (COVID-19): A Comprehensive Clinicopathologic and Immunohistochemical Study

• Published in: The American journal of surgical pathology Vol. 46; no. 4; p. 528
• Main Authors: Soares, Ciro D, Souza, Lucas L, de Carvalho, Maria G F, Pontes, Hélder A R, Mosqueda-Taylor, Adalberto, Hernandez-Guerrero, Juan C, do Nascimento Medeiros, Sanderson D, de Oliveira Sales, Alexandre, Alves, Fábio A, Lopes Pinto, Clóvis A, de Almeida, Oslei P
• Format: Journal Article
• Language: English
• Published: United States 01.04.2022
• Subjects: COVID-19; Dyspnea; Endothelial Cells; Humans; Middle Aged; SARS Virus; SARS-CoV-2
• ISSN: 1532-0979
• DOI: 10.1097/PAS.0000000000001825

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents rapid transmission and significant mortality worldwide. It is responsible for coronavirus disease 2019 (COVID-19). The disease presents diverse clinical symptoms, including fever, cough, dyspnea, and pneumonia. However, other manifestations associated with COVID-19 need to be clarified, leading specialists to an early diagnosis and better prognosis. We describe the spectrum of clinicopathologic COVID-19-related oral lesions that can be the first and/or the unique manifestation of the disease. Fourteen patients with a mean age of 58 years (range: 23 to 88 y) with oral lesions were included. All patients were confirmed to be infected with SARS-CoV-2 by reverse transcription polymerase chain reaction testing. Patients demonstrated mild symptoms, including dysgeusia, anosmia, fever, and headache. The lesions were recognized and classified into 2 groups: (1) lesions caused by ischemia and/or hemorrhage and (2) lesions secondary to inflammatory events associated with viral load. The palate was most affected (n=8), followed by the tongue (n=4), and both the lip and palate (n=2). Histologic analysis demonstrated thrombosis of small arteries and capillaries, associated with areas of hemorrhage and chronic inflammatory infiltrate. Immunohistochemistry showed positive staining for spike protein (SARS-CoV and SARS-CoV-2) and angiotensin-converting enzyme 2 in the surface epithelium, salivary glands, inflammatory cells, and endothelial cells. Although the incidence of oral lesions among patients infected with SARS-CoV-2 appears to be uncommon, these findings suggest that the oral mucosa can also be a target organ for SARS-CoV-2.