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Pathology case: Severe burning and white patches

May 17, 2023
This patient presents with the chief complaint that for the last nine days, he has had a severe burning feeling on his tongue and "white patches all over" the insides of his cheeks.

Editor's note: Originally published in November 2015. Updated May 2023.

Case presentation

A 62-year-old male presents to the office with the chief complaint that for the last nine days, he has had a severe burning feeling on his tongue and the insides of his cheeks, accompanied by “white patches all over.” His health history includes recent dry mouth, type 2 diabetes, and high blood pressure. He takes blood pressure medication and shares that he has been undergoing changes to his diabetes prescriptions to gain better control of his sugar levels.

The patient indicates that the lesions initially appeared eight months ago and his MD told him to rinse with salt water. The lesions subsided, but recently came back, worse than before. He also complains of a fetid odor to his breath that seems to be exacerbated with this recent onslaught of lesions.

Clinical exam

Clinical exam reveals white leukoplakic patches on the right and left lateral borders of the tongue and on the buccal mucosa throughout the oral cavity. A swipe with gauze removed the lesions.


  • Acute pseudomembranous candidiasis (thrush)
  • Erosive lichen planus
  • Mucus membrane pemphigoid
  • Pemphigus vulgaris
  • Discoid lupus erythematosus

Final diagnosis

Acute pseudomembranous candidiasis (thrush)

Candidiasis is an opportunistic fungal infection that presents primarily when there is compromise in the immune system of the host. Candida albicans is the most prevalent form of the eight species of Candida. It presents on the surface of the mucosa typically as white patches (may or may not rub off) or bright red inflamed tissue. Lesions associated with C. albicans include angular cheilitis (perleche), median rhomboid glossitis, and chronic mucocutaneous candidiasis. See the table below for the predisposing factors to Candidiasis1:

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  1. Saap JP, Eversold L, Wysocki G. Contemporary Oral and Maxillofacial Pathology. Mosby; 1997.