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Painful Oral Ulcers

Case Challenge Number: 23

Diagnostic Information

Additional Clinical History The patient reports a history of hemolytic anemia of unknown etiology. She is otherwise healthy and denies any history of skin or genital lesions. The patient currently is taking a multivitamin daily and reports an allergy to cephalosporins. She does not use tobacco and occasionally drinks alcohol on social occasions. Intraoral Findings Oral examination reveals bilateral white striated lesions with adjacent erythema involving the posterior buccal mucosa and mandibular vestibule. (Figures 1 and 2)

Figure 1. White, interlacing, keratotic striae and associated mucosal erythema of the right mandibular vestibule and posterior buccal mucosa.

Figure 2. White, interlacing, keratotic striae and associated mucosal erythema of the left posterior buccal mucosa.

Attempts at wiping away the lesions are unsuccessful. In addition a 5 x 5 mm ulcer with surrounding areas of mucosal atrophy is found on the left lateral border of the tongue. (Figure 3)

Figure 3. Ulcer with surrounding mucosal atrophy on the left lateral border of the tongue.

Extraoral Findings The patient appears well nourished and under no distress. No lymphadenopathy is noted upon palpation of the neck. Examination of the skin of the head, neck, trunk, and extremities does not reveal any lesions, including ulcers, vesicles, bullae, pruritic papules, or rash. Her fingernails and scalp have a normal appearance free of ridging or splitting.