SHM Converge Scientific Abstract ePoster Gallery-Plasma Cell Orificial Mucositis

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This case describes a 39-year-old woman with monthly intranasal cocaine use and a 12-pack-year smoking history who presented with a 7-month progressive ulcerative lesion of the upper lip and nose. The lesion began as a minor scratch that failed to heal and worsened acutely after her upper lip split while yawning. Exam showed saddle nose deformity, loss of nasal bridge support, a 3-cm full-thickness ulcer of the upper lip with irregular borders, and erythematous, exudative periorificial inflammation. There was no palatal involvement, oral lesions, or lymphadenopathy.<br /><br />The key diagnostic challenge was distinguishing plasma cell orificial mucositis (PCOM) from cocaine-induced midline destructive lesions (CIMDL), granulomatosis with polyangiitis, infection, lymphoma, and other causes. Workup showed elevated IgE, negative autoimmune markers (c-ANCA, p-ANCA, ANA), and negative infectious studies including fungal, bacterial, and AFB cultures. CT imaging showed soft tissue defect and nasal septal perforation without bony destruction. Biopsy was decisive, demonstrating a dense lymphoplasmacytic infiltrate with abundant eosinophils and polyclonal cells, without vasculitis, granulomas, necrotizing inflammation, or malignancy, consistent with PCOM.<br /><br />The patient was managed conservatively by plastic surgery and ENT, with infectious disease ruling out active infection and stopping antibiotics. Dermatology initiated a prednisone taper, leading to marked improvement in pain and inflammation within one week. She continued to improve after discharge.<br /><br />This case highlights that PCOM is a rare, likely underrecognized inflammatory disorder, often associated with cocaine exposure and sometimes adulterants. It can mimic CIMDL, but the two entities differ in pathology, treatment, and prognosis. PCOM typically causes localized periorificial ulceration, shows eosinophil/plasma cell-rich inflammation, and responds well to corticosteroids and cocaine cessation, whereas CIMDL causes progressive midline tissue destruction and often requires different immunosuppressive approaches. Early biopsy, exclusion of infection and autoimmune disease, and a multidisciplinary plan are essential to prevent irreversible facial disfigurement and guide delayed reconstructive surgery after inflammation is controlled and abstinence is documented.

Asset Subtitle

Sahithi Reddi

Meta Tag

Author List Jordan Barnett-Kradjian, Michael Ferrigno, Sahithi Reddi

Category Clinical Vignettes

Concept Plasma Cell Orificial Mucositis

Concept Cocaine Cessation

Concept Cocaine Use

Concept Cocaine-Induced Midline Destructive Lesions

Concept Tissue Biopsy

Distinguished Non-Finalist

Presenter Organization Stony Brook University Hospital

Presenting Author Sahithi Reddi

Track Adult

Keywords

plasma cell orificial mucositis

PCOM

cocaine-induced midline destructive lesions

CIMDL

upper lip ulceration

saddle nose deformity

eosinophilic infiltrate

polyclonal lymphoplasmacytic inflammation

prednisone taper

cocaine cessation

Plasma Cell Orificial Mucositis

Cocaine Cessation

Cocaine Use

Cocaine-Induced Midline Destructive Lesions

Tissue Biopsy