Forum for Clinical and Surgical Oral Pathology

Case BBOPF 21-1

Dr. Mitzi Palazzolo (Mississippi USA). Would like to get input on the following case BBOP 21-1. The case will be posted until January 31, 2021. A summary of the responses will ensue shortly after.

History

The patient is a young male, 5 years old of Asian ancestry. No medications, no known drug allergies, but has a history of eczema and food allergies, patch testing in the past was positive for cats/dogs and dust mites. A month ago the patient complained of discomfort palatal to E and F, the lesion appeared ulcerative, new lesions developed a week after on the right buccal mucosa and right lateral tongue. During the next 2 weeks lesions appeared to be healing, but the tongue lesion persisted a little longer than 2 weeks. Soon after, the patient developed additional ulcers on the tongue and labial mucosa. The lesions could represent a case of aphthous ulcers, major but in my experience, this is unusual in a young child before puberty. However, my practice does not typically include pediatric patients. CBC with differential was ordered and the % of neutrophils was slightly low 42.8 (normal range 45.5-74). ESR and CRP were normal. No fever, malaise, GI discomfort. Stool was monitored and no diarrhea that the parents can report. The patient has been referred to Rheumatology. I am submitting this case for additional input to see if there is value in doing additional testing for a 6 week period to monitor absolute count of neutrophils and/or other tests/treatment regimens we could accomplish. Thank you for your valuable opinions and Happy Holidays.

Images

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