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Oral Ulcer

History of Present Illness:

A 52-year-old female presents to the ED for 4 days of severe oral pain.  She denies history of same.  She has been using gentian violet for possible thrush but it has not helped.    She denies any fever or other complaints.

Vital Signs & Physical Exam:

Vital signs are normal except for   Physical exam is otherwise except for multiple oral ulcer on the buccal mucosa and under the tongue (largest shown below).

Initial Differential Diagnosis:

  • Syphilis, the great imitator
  • Aphthous ulcer

Initial Diagnostic Testing:

  • Labs: none ordered

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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ANSWERS:

  1. What does the case image show?  The image shows a large sublingual ulcer .
  2. What should you do next?  Treat with ABX, steroids and magic mouthwash.  Consult ENT.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: We’ll just have to see

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