Case #19 Discussion

Summary: These lesions are vesicular-ulcerated-erythematous   ~Acute onset of painful ulcers and erythema throughout oral mucosa   ~Tender cervical lymphadenopathy Lesions to Exclude from the Differential Diagnosis: Hereditary   ~Epidermolysis Bullosa        *Blisters and ulcers of the skin are consistently present beginning at birth or early childhood        *Tender lymphadenopathy not present Mycotic   ~Candidosis        *Does not occur predominantly as ulcers        *Tender lymphadenopathy not present Autoimmune Disorders   ~Lesions have gradual onset and are persistent   ~Tender lymphadenopathy not present Viral   ~Herpangina        *Limited to posterior oral cavity: soft palate and oropharynx   ~Varicella (Chicken Pox)        *Skin rash is most prominent feature of varicella   ~Infectious Mononucleosis        *Oral lesions, if present, are usually tonsillitis, pharyngitis, and palatal petechiae, rather than ulcers   ~Recurrent Herpes        *Occurs only on keratinized tissues   ~Varicella Zoster (Shingles)        *Vesicles and ulcers are unilateral and follow the distribution of a sensory nerve   ~Hand-foot-and-mouth disease        *Include vesicles and ulcers on the hands and feet. Idiopathic lesions   ~Aphthous Ulcers        *Occur on non-keratinized mucosa        *Lymphadenopathy not present   ~Erythema multiforme        *Lymphadenopathy not present   ~Erosive lichen planus        *Lesions have gradual onset and are persistent        *Tender lymphadenopathy not present   ~Erythroplakia        *Lesions do not occur as discrete ulcers which appear suddenly        *Tender lymphadenopathy not present   ~Medication-induced mucositis        *Tender lymphadenopathy not present   ~Contact stomatitis        *Tender lymphadenopathy not present Lesions to Include in the Differential Diagnosis: Primary Herpes   ~Acute onset of ulcers throughout the oral mucosa accompanied by tender cervical lymphadenopathy Management: Treatment includes palliative care with an emphasis on maintaining hydration. Systemic antiviral medications such as acyclovir would be of little value since the lesions have been present for four days.  Educate the patient about the viral nature of the disease and the possibility for recurrence. Final Diagnosis: Primary Herpetic Gingivostomatitis (Primary Herpes)