Oral ulcers and mucosal disease — structured clinical encounter

Structured encounter testing the approach to a febrile drooling two-year-old with diffuse painful anterior gingival ulceration: the diagnosis of primary herpetic gingivostomatitis, the hydration-first assessment, and early oral aciclovir within 72 hours, with a pivot to a school-age child with recurrent scarring major aphthae requiring the deficiency and coeliac work-up and the differential of systemic aphthosis.

structured clinical encounter2 min readVerification in progress

Prompt

A two-year-old boy has three days of high fever, drooling and refusal of all fluids. The gingiva is diffusely swollen, red and bleeding, with shallow vesicles and ulcers across the gingiva, tongue and lips and tender cervical lymphadenopathy. You are the paediatric registrar working through the hydration-first assessment and early oral aciclovir, with a later scenario of a ten-year-old with recurrent scarring major aphthae requiring the deficiency and coeliac work-up.

Candidate brief

You are the paediatric registrar in the emergency department. A two-year-old boy has three days of high fever, drooling and refusal of all fluids. On examination his gingiva is diffusely swollen, red and bleeding, with shallow vesicles and ulcers across the gingiva, tongue and lips and tender cervical lymphadenopathy. [1]

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References4Show ledger

[1]Amir J; Harel L; Smetana Z; et al Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study. BMJ, 1997.PMID 9224082
[2]Coppola N; Cantile T; Adamo D; et al Supportive care and antiviral treatments in primary herpetic gingivostomatitis: a systematic review. Clin Oral Investig, 2023.PMID 37733027
[9]Lau CB; Smith GP Recurrent aphthous stomatitis: A comprehensive review and recommendations on therapeutic options. Dermatol Ther, 2022.PMID 35395126
[10]Barrons RW Treatment strategies for recurrent oral aphthous ulcers. Am J Health Syst Pharm, 2001.PMID 11194135