ORAL ULCERS IN CHILDREN
- Any chance of burn?
- Any prior known dx of HSV stomatitis? (If so, makes present dx of primary HSV stomatitis less likely since would expect clinical picture of recurrent oral HSV i.e. single lesion at vermilion border of lip)
- Signs/sx of meningitis? (viral meningitis may occur with certain strains of viruses that can cause hand/foot/mouth disease; see below)
- Signs of candidiasis, i.e. white placque?
- Look at distribution of lesions in oropharynx-are buccal mucosae involved? How about tonsils (if so, suggests herpangina;see below)
- Check hands/feet for lesions (see hand/foot/mouth disease below)
- Cervical lymphadenopathy?
- Signs of ocular involvement (eye involvement in HSV infections can be serious)
III. Differential dx:
- Primary HSV stomatitis (usually 1wk incubation; vesicles that become yellow after rupture with red halo; clinical presentation can include fever, irritability; cervical lymphadenopathy)
- Herpangina (tonsils/soft palate vesicles and ulcers; inc. 4d; fever, ST, abd pain/vomiting; us. resolves after 3-5d)
- Hand/foot/mouth (fever, vesicles/ulcers on palate, tongue, and buccal mucosa + small tender lesions on hands, feet, buttocks, and sometimes genitalia; resolves after 2-3d; can get viral meningitis)
Tx for HSV stomatitis: Oral acyclovir 15mg/kg (max 200mg) 5x/d for 5-7d may reduce duration and severity of symptoms