Oral lesions in SARS-COV-2 infected patients: could the oral cavity be a target organ?

Brandão, Thaís Bianca; Gueiros, Luiz Alcino; Melo, Thayanara Silva; Prado-Ribeiro, Ana Carolina; Nesrallah, Ana Cristina Froelich Alo; do Prado, Gladys Villas Boas; Santos-Silva, Alan Roger; Migliorati, Cesar Augusto

Several viruses transmitted through saliva, such as herpes simplex virus, cytomegalovirus and Zika virus are capable of infecting and replicating in the oral mucosa leading to painful oral ulcers. Few studies have described COVID-19 oral manifestations. There is growing evidence that angiotensin-converting enzyme 2 (ACE2), the main host cell receptor of SARS-CoV-2, is highly expressed on the epithelial cells of the tongue and salivary glands, which may explain the development of dysgeusia in COVID-19 patients. Hence, it is important to understand if SARS-CoV-2 can infect and replicate in oral keratinocytes and fibroblasts, causing oral ulcerations and superficial necrosis. Herein we report a series of eight cases of COVID-19 infected patients with oral necrotic ulcers and aphthous-like ulcerations affecting tongue, lips, palate and oropharynx that developed early in the course of disease following the development of dysgeusia. A short review of the literature regarding the important role of ACE2 in SARS-CoV-2 cellular entry is also provided bringing new insights to oral keratinocytes and minor salivary glands as potential targets.