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Methotrexate is a chemotherapy originally used in oncology that is also applied in several nononcologic diseases, such as rheumatoid arthritis, because it has an anti-inflammatory effect in low doses. A 68-year-old leucoderm man attended our service with complaint of oral sores for 1 month. As a personal background he had rheumatoid arthritis, diabetes, hypertension, and hypothyroidism. The patient said the ulcers began to appear after the dose of methotrexate had been changed. Clinical history and anamnesis as well as a conversation with his physician led to the conclusion that a possible methotrexate toxicity was related to the oral ulcers despite the use of the medication in low doses (25 mg weekly). Extensive sore of the oral mucosa, especially in the labial lips region, was observed with a yellowish membrane. This case report aims to demonstrate that the toxic effects of methotrexate are seen even in low doses.

Ameloblastoma is an odontogenic tumor of epithelial origin and occurs in approximately 1% of all tumors and odontogenic cysts. The treatment selection is a block resection with reconstruction and the conservative treatment is restricted to young patients with unilocular ameloblastoma. The reported case is about a 25-year-old male patient, with leukoderma, whose complaint was the evident volumetric increase causing deformation and facial asymmetry. Clinically, the residual root of tooth 36 and ectopy of teeth 37 and 38 that were lingual and with the deletion of the southern bottom of the region were observed. At radiographic examination, there was extensive and circumscribed radiolucent image. After puncture and aspiration the incisional biopsy was performed, and the drainage tube was placed in the same act. After histologic confirmation the patient was followed for 9 months and submitted to enucleation followed by cryosurgery and is without signs of relapse.

Medicated oral ulcers are often observed in patients who use antineoplastic drugs. Afatinib is an orally administered, irreversible inhibitor of the ErbB family of tyrosine kinases. It is the first-line treatment of patients with non–small cell lung cancer (NSCLC) with activating epidermal growth factor receptor (EGFR) mutations. During the treatment, some adverse effects such as epistaxis, diarrhea, nausea, vomiting, aphthous stomatitis, rash, acneiform dermatitis, pruritus, and xeroderma can be observed. We present a case of a 63-year-old female patient with advanced EGFR-mutated NSCLC and started treatment with oral afatinib 40 mg daily. On clinical examination there were atopic lesions located on the mucosa of the soft palate, lips, and tongue as well as involvement of the nails. This case demonstrates aphthous stomatitis as an adverse effect of antineoplastic medication that should be placed as a differential diagnosis in patients who use afatinib.

The idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease of unknown cause being attributed by some authors as an immune response to some types of vaccine as a trigger of the disease. It is estimated that 10 in every 100,000 middle-aged individuals develop the disease. The first treatment choice is corticosteroids, and the diagnosis is performed with clinical evidence of bleeding, bruises, epistaxis, petechiae, and hematologic tests that confirm intense thrombocytopenia. This case report is about a melanoderma patient, 34 years old, who had a sudden appearance of bruising on various areas of the body and presence of petechiae and hemorrhagic blisters in the oral cavity. Hematologic examinations showed intense thrombocytopenia (30,000 platelets); the patient was treated with a corticosteroid and bevacizumab without adequate response and because it was a refractory disease, the patient underwent chemotherapy with vincristine leading to remission of the disease.

Granulomatosis with polyangiitis, formerly known as Wegener’s granulomatosis, is a potentially fatal systemic auto-immune disease, and it mainly affects small- and medium-sized blood vessels. It is characterized by necrotizing granulomatous lesions of the respiratory tract, vasculitis, and glomerulonephritis, and it could develop in various organs, especially the ear, nose and throat, lungs, and kidneys. In addition, 50% of cases show orbital involvement. This study presents a rare case of Wegener’s granulomatosis. A 62-year-old male had a complaint of thrush in both tongue margins and also had ocular lesions and involvement of the feet and hands. Due to the extensive ulcers we did an incisional biopsy, which revealed severe vasculitis and inflammatory infiltrate compatible with Wegener’s disease. Thereafter, we prescribed mouthwashing with benzydamine and a systemic corticosteroid. The treatment caused the lesions to disappear completely.