History of Present Illness
This is a 39-year-old white female who first noticed a few nonhealing oral ulcers that started at the end of 2004. They included generalized gingiva (both maxilla and mandible) (Fig 1) and progressively worsened to involve the palate and floor of mouth. The oral ulcerative lesions were associated with severe pain. In early May 2005, she presented to the University of Washington Oral Medicine Clinic for an evaluation at which she was referred to the Department of Oral Surgery for a biopsy, which was submitted for both light H & E histology and direct immunofluorescence studies. She denied any skin changes, swallowing problems, throat soreness, chest pain, chest fullness, or any vaginal or anal lesions. Her last visit to her gynecologist was in April 2005, and the results were normal. Based on the pathology report, she was referred to a dermatologist who placed her on steroid treatment.