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Painful Oral Ulcers
DIAGNOSTIC INFORMATION

Case Author(s): Angela C. Chi, DMD; Brad W. Neville, DDS

Additional Clinical History

The patient reports a history of hemolytic anemia of unknown etiology. She is otherwise healthy and denies any history of skin or genital lesions. The patient currently is taking a multivitamin daily and reports an allergy to cephalosporins. She does not use tobacco and occasionally drinks alcohol on social occasions.

Intraoral Findings

Oral examination reveals bilateral white striated lesions with adjacent erythema involving the posterior buccal mucosa and mandibular vestibule. (Figures 1 and 2)

striae and erythema on right
Figure 1. White, interlacing, keratotic striae and associated mucosal erythema of the right mandibular vestibule and posterior buccal mucosa.
striae and erythema on left
Figure 2. White, interlacing, keratotic striae and associated mucosal erythema of the left posterior buccal mucosa.

Attempts at wiping away the lesions are unsuccessful. In addition a 5 x 5 mm ulcer with surrounding areas of mucosal atrophy is found on the left lateral border of the tongue. (Figure 3)

mucosal atrophy
Figure 3. Ulcer with surrounding mucosal atrophy on the left lateral border of the tongue.

Extraoral Findings

The patient appears well nourished and under no distress. No lymphadenopathy is noted upon palpation of the neck. Examination of the skin of the head, neck, trunk, and extremities does not reveal any lesions, including ulcers, vesicles, bullae, pruritic papules, or rash. Her fingernails and scalp have a normal appearance free of ridging or splitting.

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