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Herpangina - Oral Mucosal Lesion
Other Resources UpToDate PubMed

Herpangina - Oral Mucosal Lesion

Contributors: Chris G. Adigun MD, Jeffrey D. Bernhard MD, Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc
Other Resources UpToDate PubMed


Herpangina is an infection caused by multiple types of coxsackie viruses (most often A5, A6, A8, A10, and A16), echoviruses, and enterovirus 71. It characteristically begins with acute onset of fever, headache, and sore throat complicated by dysphagia, loss of appetite, and less commonly stiff neck. In all cases, patients present with single or multiple yellowish-gray to white raised 1-2 mm papulovesicles in the throat, surrounded by a ring of intense erythema. Diffuse pharyngeal hyperemia is present. These lesions occur most frequently on the anterior faucial pillars, tonsils, uvula, and/or soft palate. Patients may have only one or two of these lesions, or the entire pharynx may be essentially covered with them. Clusters of lesions may coalesce. Lesions progress to ulceration, leaving shallow, slightly depressed grayish craters 2-4 mm in diameter. They spontaneously resolve in 5-10 days.

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

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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.

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Last Updated:05/20/2013
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Herpangina - Oral Mucosal Lesion
A medical illustration showing key findings of Herpangina : Fever, Headache, Oral erosions, Dysphagia, Pharyngitis
Clinical image of Herpangina - imageId=4772543. Click to open in gallery.  caption: 'Slough-covered erosions on the left palate.'
Slough-covered erosions on the left palate.
Copyright © 2023 VisualDx®. All rights reserved.