Case #8:

Case profile:

Patient: Mentally retarded boy

Case record:

Chief Complaint: The patient has persistent oral discomfort of one month duration which involves the entire oral mucosa. Penicillin therapy increased the discomfort. The patient reports a thick, white toenail.   Medical History: The patient has just completed a 14 day course of penicillin, 250 mg, four times a day, prescribed for the chief complaint. A heart murmur was identified at birth but was not present at age ten. The patient had pneumonia at age three. He has acne.   Dental History: A maxillary central incisor was avulsed and a lip was lacerated at age eight. The oral hygiene is poor.   Clinical Findings: The entire oral and pharyngeal mucosa is tender and erythematous, with white plaques which rub off. The gingiva is swollen, compressible and blanches. Compressible, nonfixed submandibular and anterior cervical lymph nodes are palpable. Submandibular lymph nodes are tender to palpation. Other clinical findings include bilateral angular cheilitis, erythema around the nose, and white plaques on the tympanic membrane.

Images:

Teeth, Gingiva, Buccal Mucosa LG   Maxillary Anterior Teeth and Upper Lip LG Ventral tongue LG Lower Lip, Everted LG Left Buccal Mucosa LG Palate and Maxillary Teeth LG   Anterior Tongue, Dorsal and Lateral Surfaces LG Anterior Tongue and Lower Lip LG