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Japanese male patient with extensive, black-pigmented and irregularly bordered macule in the maxillary labial mucosa and midline facial gingiva, (teeth 8 and 9)

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The apoptosis involved in SIMI encompasses the activation or inhibition of multiple pathways, including TNF- and MAPK-related, PI3K/AKT/mTOR, and NF-B signaling pathways, with the release of various inflammatory factors that directly lead to myocardial damage, resulting in increased secretion of inducible NO synthase and excessive production of NO (98,104)

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