Pathology · patient case question
Which condition is most important to distinguish from this presentation in a patient with widespread oral ulceration?
Patient case: Vesiculobullous Disease
demo: 55-year-old female
chief: “Spicy food burns terribly and my gums peel.”
history: Six-month history of oral ulceration preceding any skin involvement. No fever.
meds: None
findings: Diffuse buccal mucosal erythema with ragged erosions, desquamative gingivitis, and flaccid bullae that rupture readily. Gentle lateral pressure on adjacent normal-appearing mucosa produces a new blister.
Show answer and explanation
Correct answer: D. Primary herpetic gingivostomatitis
- A. Fissured tongue is a developmental grooving of the dorsum, unrelated to blistering disease.
- B. An amalgam tattoo is a stable pigmented macule with no inflammatory component.
- C. Geographic tongue is an asymptomatic or mildly sensitive migratory pattern on the dorsal tongue with no ulceration.
- D. Correct. Primary herpetic gingivostomatitis also produces widespread oral ulceration and painful gingivae, but it is acute, febrile, occurs mostly in children, is preceded by vesicles on keratinized tissue, and is self-limiting over 10–14 days.