Pathology case: Fire-engine red gingival tissue with perioral lesions

Editor's note: Originally published in September 2017. Updated December 2024.

Patient history

A healthy two-year-old male went to his primary care physician for a checkup and to assess a lump on the right side of his neck. During the examination, several ulcer-like lesions on the buccal mucosa were noted intraorally. Appetite, temperature, and overall demeanor were within normal limits. The physician diagnosed the child with hand, foot, and mouth disease.

Presentation a week later

Within a week’s time, the gingival tissue became fire-engine red intraorally, and manifestation of numerous perioral lesions became evident. Fever and loss of appetite commenced, myalgia became present in the head and neck area, and overall the child was irritable. There were no lesions on the hands or feet. It is also worthy to note that the patient's two older siblings began to manifest the same signs and symptoms six days later.

Differentials

• Hand, foot, and mouth disease
• Herpangina
• Acute primary herpetic gingivostomatitis
• Varicella (chicken pox)

Definitive/final diagnosis

Acute primary herpetic gingivostomatitis

Treatment rendered

• Palliative
• Liquids with caloric value
• Prescriptions:
  * Topical oral anesthetics—Orabase with benzocaine or lidocaine HCL 2% viscous solution
  * Acyclovir ointment 5%
  * Acyclovir 5%/lidocaine 2% compounded in a paste for perioral application
• Must monitor for secondary infections, especially if the patient is young and has a tendency not to leave the area alone
• The patient and his siblings had a full recovery after three to four weeks.