PMC6787949_01
Zone of hair loss.
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In 2006, the patient experienced partial hair loss over an area ~1 cm in diameter on the head (Figure 1).
Ulceration of the oral mucosa.
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In January 2014, the patient was admitted to the Stomatological Hospital, and physical examination showed that the oral lesions (Figure 2) resembled LP.
PMC6787949_02
A, The medial mucosal surfaces of the labia minora had bright red-colored, defect-like lesions, and the vaginal orifice was stenosed with a diameter of 1 cm. Blue arrow: narrow urethral orifice; Black arrow: defect of the mucosa. B, The medial mucosa of the labia minora was smooth and slightly reddened, and the vaginal opening was slightly narrowed. C, The mucosa of the medial labia minora was slightly reddened, smooth, and without defects.
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A small speculum was unable to expose the cervix (Figure 3A). Physical examination revealed that the mucosa of the labia minora was smooth, the frenulum labiorum pudendi was lightly chapped and the vaginal elasticity had improved, although the upper vagina still had a ring-like narrowing and no folds (Figure 3B). Gynecological examination showed that the mucosa of the medial labia minora was slightly reddened, smooth, and without defects, the elasticity of the vaginal mucosa was good, and two fingers could be accommodated (see Figure 3C).
Biopsy of right buccal mucosa (taken beside the ulcer) showing squamous epithelial mucosa and squamous epithelial dyskeratosis. A, Superficial zonular lymphocytes and plasma cells were distributed in the lamina propria, and there was small vessel hyperplasia. Scale bar: 100 mum. B, Lymphocytes were scattered within the epithelium (black arrows). Scale bar: 50 mum.
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Vaginal wall biopsy. A, Squamous epithelial mucosa, with simple and pseudoepithelioma-like hyperplasia (white arrow) in some epithelium, hyperkeratosis and incomplete keratosis, and hyperplasia of interstitial small vessels (black arrow) Scale bar: 100 mum. B, Squamous epithelial mucosa, atrophy of part of the squamous epithelium, scattered superficial dermis, infiltration of focal lymph and plasma cells, and formation of lymphoid follicles (yellow arrows). Scale bar: 100 mum.
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The pathological sections were considered to have squamous epithelial mucosal tissue, partial epithelial atrophy, partial simple hyperplasia, hyperkeratosis and incomplete keratosis, scattered focal infiltration of lymphocytes and plasma cells in the superficial dermis with formation of lymphoid follicles, and small vessel hyperplasia (Figure 5A and B).
Measurement of urine flow rate. A, A maximum urine flow rate of 5.2 mL/s was measured before treatment with urethral dilatation and oral cyclosporine A. B, A maximum urine flow rate of 11.5 mL/s was measured after treatment with urethral dilatation and oral cyclosporine A.
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Since the patient had not tolerated the adverse side effects of corticosteroid therapy during previous treatment and had fertility requirements, she was treated with oral cyclosporine A (125 mg/day) combined with physical dilatation of the urethra, and this resulted in an increase in urine flow rate to 11.5 mL/s (Figure 6B).