Herpangina - Oral Mucosal Lesion
Herpangina may affect any age group but predominates among infants and children under the age of 5. Rare neurologic manifestations have been reported and include brain stem encephalitis. Febrile seizures have been reported.
B08.5 – Enteroviral vesicular pharyngitis
186659004 – Herpangina
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.