History of Present Illness

This is a 48-year-old white female who presented to the University of Washington School of Dentistry DECOD Clinic complaining mainly of soreness under her upper partial denture, which was constructed three months prior to this episode. The clinical examination revealed multiple non-specific ulcerations of the maxillary (Fig 1) and mandibular edentulous alveolar ridges, and the posterior hard palate. The ulcers had been present for four days and were getting progressively worse. The skin manifestation was in the form of rashes on her extremities, chest (Fig 2), back and face. Within a week, she developed extensive skin lesions, for which she was hospitalized. There was skin peeling on the hands that lasted for five weeks (Fig 3). After seven weeks, the skin lesions healed, but the oral ulcers were still present, though less prominent.

Fig 1. This clinical photograph is taken at week 1. It illustrates multiple irregular ulcers on the edentulous maxillary alveolar ridge and a small ulcer involving the mucosa covering a small torus palatinus.

Fig 2. This clinical photograph is taken at week 1. It illustrates extensive skin rash involving the chest, upper extremities, neck and shoulders.

Fig 3. This clinical photograph is taken at week three. It illustrates continued sloughing of the hand skin.