A 4-year-old child presents to your office in July with a history of a low-grade fever (38.1°C) and "s ores" in his mouth for 2 days. He has been refusing to eat but has been drinking an adequate amount of liquids. On examination, he is afebrile and seems well hydrated. He has ulcers on his tongue and posterior pharynx, which are 4 mm in diameter. You also note a few vesicles on his hands and feet, which are 34 mm in size and mildly tender.
Which of the following is the most likely diagnosis?
- herpes simplex virus (HSV)
- coxsackie virus
- aphthous ulcers
- Behçet syndrome
- traumatic ulcers
Answer(s): B
Explanation:
Coxsackie A16 is the major cause of hand, foot, and mouth disease. This is a summer enteroviral illness presenting with classic lesions of the hand, feet, and mouth. Herpetic gingivostomatitis is the most common cause of stomatitis in children aged 13 years. There is often a high fever, fetor oris, refusal to eat, and irritability. The lesions are initially vesicular, and soon form ulcers ranging from 2 to 10 mm in diameter. The tongue, cheek, and gums are usually involved, and there may be submaxillary lymphadenitis. Aphthous ulcerations (canker sores) are painful ulcerations, which present as erythematous, indurated papules that erode to form circumscribed necrotic ulcers with gray fibrinous exudates and erythematous halo. They are 210 mm in diameter, heal spontaneously, and often recur. Behçet syndrome is a multisystem disorder characterized by recurrent oral and genital ulceration, iritis or uveitis, as well as other cutaneous, arthritic, neurologic, vascular, and gastrointestinal (GI) manifestations. It is rare in children. Traumatic oral ulcers may be seen in chronic cheek biters but do not involve extremities.