Codes

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

• Hand-foot-and-mouth disease – Also caused by enteroviruses. Ulcers are more diffusely distributed on the oral mucosa. Most affected patients have 1-2 mm erythematous macules or vesicles on the palms and/or soles.
• Primary herpetic gingivostomatitis (see orofacial herpes simplex virus) – Most patients have small shallow ulcers that are quite painful and distributed on all of the oral mucosal surfaces.
• Aphthous stomatitis – Usually only 1-3 lesions are present and not localized to the posterior palate. A history of recurrent lesions is also helpful.
• Drug eruption – Usually not localized to soft palate / oropharyngeal mucosa.
• Infectious mononucleosis – Affects a slightly older age group; prominent lymphadenopathy is present, and oral ulcers are rarely seen.
• Lymphonodular pharyngitis – Another enterovirus infection. The oral lesions consist of yellow-white papules that are not ulcerated.
• Oral candidiasis – Does not cause ulcers and is not associated with fever.
• Varicella – Pruritic cutaneous vesicles and ulcers are more prominent than the intraoral ulcers that may also develop.

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required