A two-year-old male presents with a previous diagnosis from his primary care physician, numerous perioral lesions, and several other physical symptoms. Based on the patient history and presentation of symptoms a week later, what are your recommendations for treatment?
Editor's note: This article first appeared in DE's Breakthrough Clinical with Stacey Simmons, DDS. Find out more about it and subscribe here.
PATIENT HISTORY: A healthy two-year-old male went to his primary care physician for a checkup and to assess a lump on the right side of his neck. During the examination, several ulcer-like lesions on the buccal mucosa were noted intraorally. Appetite, temperature, and overall demeanor were within normal limits. The physician diagnosed the child with hand, foot, and mouth disease.
PRESENTATION A WEEK LATER: Within a week’s time, the gingival tissue became fire-engine red intraorally, and manifestation of numerous perioral lesions became evident. Fever and loss of appetite commenced, myalgia became present in the head and neck area, and overall the child was irritable. The photo below shows how the patient presented. There were no lesions on the hands or feet. It is also worthy to note that the patient's two older siblings began to manifest the same signs and symptoms six days later.
Given this information, what is your impression of the case, differential diagnosis, and recommendations for treatment and follow-up care?
Send your answers to [email protected] or join our Facebook group to discuss this oral pathology case and more. Next month, we will discuss the final diagnosis and recommended treatment for this case.
Editor's note: This article first appeared in DE's Breakthrough Clinical with Stacey Simmons, DDS. Find out more about it and subscribe here.
For more oral pathology articles, click here.
Do you have an interesting oral pathology case you would like to share with Breakthrough’s readers? If so, submit a clinical radiograph or high-resolution photograph, a patient history, diagnosis, and treatment rendered to: [email protected]. We will let you know if we select your case.
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Stacey L. Simmons, DDS, is in private practice in Hamilton, Montana. She is a graduate of Marquette University School of Dentistry. Dr. Simmons is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. She is the editorial director of PennWell’s clinical dental specialties newsletter, DE’s Breakthrough Clinical with Stacey Simmons, DDS, and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. Dr. Simmons can be reached at [email protected].
