Sobrediagnóstico de candidiasis oral en atención primaria: liquen plano oral erosivo en un paciente joven
DOI:
https://doi.org/10.15517/6d16a738Palabras clave:
Liquen plano oral; Candidiasis oral; Diagnóstico diferencial; Mucosa oral; Lesiones orales; Úlcera bucal.Resumen
La candidiasis oral es una de las infecciones fúngicas más frecuentes y su diagnóstico suele ser clínico; sin embargo, su sobreinterpretación puede llevar a confundir otras patologías con características similares; como el liquen plano oral (LPO), una enfermedad inflamatoria crónica de origen inmunológico. El objetivo de este trabajo es describir un caso de LPO erosivo inicialmente tratado como candidiasis, para enfatizar el diagnóstico diferencial ante lesiones ulcerativas persistentes. Paciente masculino de 19 años consultó por múltiples erosiones y ulceraciones difusas dolorosas que dificultaban el habla y la alimentación, con intensidad de dolor de 10/10 en la escala visual análoga. Inicialmente fue diagnosticado con candidiasis oral en atención primaria y tratado con nistatina sin mejoría. El examen clínico mostró compromiso bilateral de mucosa yugal y labial con lesiones erosivas y ulceradas en mucosa labial y yugal, junto con placas blanquecinas en red compatibles con estrías de Wickham y signo de Nikolsky negativo. Se planteó diagnóstico clínico de LPO erosivo, confirmado mediante estudio histopatológico. Se indicó tratamiento con corticosteroides sistémicos con descenso progresivo y nistatina nocturna como profilaxis antimicótica, con resolución clínica completa al mes y evolución estable a dos años con episodios leves asociados a trauma/estrés. El diagnóstico diferencial adecuado de lesiones orales es esencial para un manejo oportuno. Las lesiones orales eritematosas o ulceradas que no responden a antifúngicos deben reevaluarse e incluir LPO en el diagnóstico diferencial. La biopsia y la correlación clínico-patológica permiten evitar errores diagnósticos y tratamientos innecesarios.
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