Forum for Clinical and Surgical Oral Pathology

Case BBOPF 07-1

Dr. Robert S. Baratz (Department of Medicine, Boston University School of Medicine) is sharing with the BOBP community one of his cases. This case was posted from February 28 to March 8, 2007. A summary of the responses will be posted in BBOP.

Clinical History

It is Friday afternoon and a patient comes to your office. You've never seen him before. He is a recently married 28 year old food service manager, born in India, but living in the USA for six years. He has no chronic illnesses and takes no regular medications. He had traveled to India two months ago for his wedding, as did his wife.

He presented to his physician three days ago, after his lower lip began to swell. He had no symptoms of an upper respiratory infection, nor did he have any pain, nor a facial rash. He had never had an episode of herpes (simplex) labialis, nor had his wife. He reported this all began the day before with a single lesion at the vermillion border which seemed like a "pimple", which he manipulated, but of which he was unable to express anything.

The clinician, who was unavailable for discussion, put him on valacyclovir, a topical antiviral and cetirizine. His lip continued to swell over the next two days. Last evening he had a fever of 101 degrees F, took naproxen and the fever abated. He has no paresthesias. The lip is sore to the touch, but not exquisitely painful. He is uncomfortable. There is mild submental and submandibular tender lymphadeonpathy only on the left side. Intraorally he has no lesions, and only has early caries in teeth #'s 17 and 32. There was no trauma. His bite is normal. He has no restorations, and no odontalgia. His periodontium appears completely normal, as do his other mucosae, and the tongue. He has very mild acne on his back, non-pustular type, and no other medical findings. A physical exam is otherwise unremarkable. He reports his lip is very dry, and has split open a bit with a small amount of serosanguinous exudate.

• What is your diagnosis?
• What is your treatment?

Two photographs follow.

Robert S. Baratz, MD, PhD, DDS
Department of Medicine, Boston University School of Medicine
Departments of Medicine and Surgery, Quincy Medical Center
Medical Director, South Shore Health Center

Images

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Case prepared by Dr. Alfredo Aguirre (BBOP Manager) and Daniel Emmer (Web Administrator, University at Buffalo School of Dental Medicine).