LAUSR

Objective The aim of this report is to present the process of diagnosis and management of a patient with myelodysplastic syndrome afflicted with recurrent aphthous stomatitis (RAS). Background RAS is one of the most common lesions of the oral mucosa seen in adolescents. Although the exact etiology of RAS is still unknown, different hematinic deficiencies have been proposed. Case Report A 71-year-old male patient with multicomorbidities suffered from frequent oral ulcerations for many years. Hematologic investigation showed normal iron serum concentration and higher folate levels. In addition, his serum zinc concentration was low. Although his vitamin B12 level was normal, his homocysteine level was slightly high. Furthermore, his red blood cell count, hemoglobin, and hematocrit were low, and mean corpuscular volume, mean corpuscular hemoglobin, and red blood cell distribution width were high, which were related to megaloblastic anemia. Treatment with prednisolone, zinc gluconate, hydroxocobalamin, and nystatin led to rapid improvement. Nevertheless, fluctuations in the state of his RAS occurred within 6 months. Hence, we consulted the Division of Hematology and Oncology for further evaluation. The hematology and oncology doctor arranged blood tests and bone marrow biopsy and prescribed ferrous gluconate-B. The bone marrow biopsy showed myelodysplastic syndrome, refractory cytopenia with multilineage dysplasia, and iron store deficiency. After iron supplementation, his recovery rate improved. Clinical Implication When patients have RAS, consider checking iron, vitamin B12, and folate levels and treating patients if levels are low. Such treatment could reduce some varieties of RAS. However, in patients with hematological diseases, further tests, such as bone marrow biopsy, may be needed.