key: cord-1034698-hogyuv9c authors: da Mota Santana, Lucas Alves; Sousa‐e‐Silva, Nelmara; Gonçalo, Rani Iani Costa; de Oliveira, Eduardo Morato; de Oliveira Corrêa, Ricardo; Moreno, Amália; de Souza, Leandro Napier title: Persistent hyposalivation in patients after COVID‐19 infection: Temporary or lasting alteration? date: 2021-08-17 journal: Oral Surg DOI: 10.1111/ors.12660 sha: ce44ae196ace1fa4759367a8dd12bcfe7898bb79 doc_id: 1034698 cord_uid: hogyuv9c Abstract It was with great interest that we read the letter written by Martelli Júnior et al. (2021).1 To our knowledge, it is the first study to evaluate the frequency of alterations in salivary glands by COVID-19 in Brazil. The COVID-19 is a defiant infectious disease due to systemic complications and potential sequelae.2 The invasion of oral epithelial cells by SARS-CoV-2 may result in damage to glandular parenchyma. To The Editor: It was with great interest that we read the letter written by Martelli Júnior et al (2021) . 1 To our knowledge, it is the first study to evaluate the frequency of alterations in salivary glands by COVID-19 in Brazil. The COVID-19 is a defiant infectious disease due to systemic complications and potential sequelae. 2 The invasion of oral epithelial cells by SARS-CoV-2 may result in damage to glandular parenchyma. 3 However, few studies have focussed on long follow-up of oral disorders in patients post-COVID-19. With this in mind, we reported the case of persistent hyposalivation 1 year after the initial infection by SARS-CoV-2. An 85-year-old female presented on June 15, 2020, with fever, cough and shortness of breath. The physical examination revealed 38℃ body temperature and 91% oxygen saturation in room air. The patient was hospitalized for 10 days with daily oxygen supplementation and administration of corticosteroids and antibiotics. Posteriorly, the RT-PCR result confirmed the diagnosis of COVID-19. After the gradual restoration of saturation levels, the patient was released. In subsequent days, the patient's complaints of hyposalivation, dry mouth and progressive worsening of symptoms, including difficulty in swallowing caught our attention (Figure 1 ). For this reason, she was conducted to our oral medicine clinic and is under specialist care with the use of sialagogues, artificial saliva and psychological assistance. There was no previous history of hyposalivation or any salivary gland disorder. SARS-CoV-2, similarly to other viruses, may induce an inflammatory process in salivary glands with related cases of parotitis. 4 In his groundbreaking work, Soares et al (2021) 3 found immunohistochemically high expression of ACE2 in vessels and ductal structures, demonstrated that intraoral SGs may be involved in COVID-19 pathogenesis. Consequently, the damage to acinar cells is repaired by fibroblast proliferation and subsequent fibrous repair and hyperplasia are accompanied by stenosis of the ducts of salivary glands, resulting in hyposecretion. 5 The linkage between vascular events in patients with COVID-19 and alterations in salivary glands is still unclear, however, some paths can be taken to elucidate this potential correlation. Haemostatic abnormalities have been related to COVID-19 in the form of venous thromboembolism, amongst them, the antiphospholipid syndrome-an autoimmune disorder, 6 that may reflect even in salivary glands physiology. 7 Moreover, coagulation favours fibrosis, especially by activation of mesenchymal cells that differentiated in myofibroblasts and contribute to the high deposition of extracellular matrix components and eventual loss of tissue function. 8 Increase in the number of Sjögren's syndrome cases in Brazil in the COVID-19 Post-acute COVID-19 syndrome Immunohistochemical expression of angiotensin-converting enzyme 2 in minor salivary glands during SARS-CoV-2 infection Acute parotitis as a presentation of COVID-19? Oral symptoms associated with COVID-19 and their pathogenic mechanisms: a literature review Presence of antiphospholipid antibodies in COVID-19: case series study Parotid swelling due to external carotid artery thrombus-a rare manifestation in antiphospholipid syndrome Coagulation and coagulation signalling in fibrosis Long-term respiratory and neurological sequelae of COVID-19