History of the present illness

This is a 14-year-old white male who came to the Department of Oral Medicine of the University of Washington, School of Dentistry with a chief complaint of not being able to eat or drink because of generalized oral ulcers and sloughing epithelium that had been present for eight weeks. The ulcers started at the mucosal area of the lower inner lip (Figure 1) and later spread to his entire mouth except for the outer lips. This included the gingiva, bilateral buccal mucosae and vestibules (Figure 2), the floor of his mouth (Figure 3), the soft palate and throat (Figure 4), and inner lips. He was given a Benadryl and Maalox rinse as well as amoxicillin, to no effect. He was having difficulty eating and drinking and as a result lost 15 pounds. Extra-orally, he developed sores in his left eye which responded to eye drops and ointment, and later in his right eye which responded to anti-inflammatory ointment but recurred.

Figure 1 This is a clinical view of the lesions at the first week of January 2011 demonstrating generalized ulceration of the lower lip. The ulcers are superficial and irregular and are covered by pseudomembrane.

Figure 2 This is a clinical view of the lesions at the second week of January 2011 demonstrating generalized ulceration of the mandibular vestibule and buccal mucosa. Like the other areas of the mouth, the ulcers are superficial and irregular and are covered by pseudomembrane.

Figure 3 This is a clinical view of the lesions at the first week of January 2011 demonstrating generalized ulceration of the floor of mouth. Like the lower lip, the ulcers are superficial and irregular and are covered by pseudomembrane.

Figure 4 This is a clinical view of the lesions at the first week of January 2011 demonstrating generalized ulceration of the uvula and soft palate area. Like the other areas of the mouth, the ulcers are superficial and irregular and are covered by pseudomembrane.