Key Notes on Oral Ulcers - Part 2

Cytomegalovirus Infection

  • Risk factors: age, low socio-economic status, crowded living conditions.
  • Primary infection may be asymptomatic or resemble mononucleosis.
  • Common in immunocompromised individuals.
  • Established latency in connective tissue cells.
  • Transmission: intimate contact, vertical transmission, blood products, transplanted organs.

Clinical Findings of CMV Infection

  • Symptoms: fever, malaise, leucopenia.
  • Gastroenteritis most common, also can cause pneumonitis, retinitis, hepatitis.
  • Neonatal infections may present with hepatosplenomegaly, cutaneous erythropoiesis, thrombocytopenia.

Oral Manifestations of CMV

  • Single or multiple painful ulcers in immunocompromised patients.
  • Coinfections with HSV or VZV are common.

Diagnosis & Management of CMV

  • Diagnosis: real-time PCR, biopsy revealing "owl eye" cells.
  • Pain management: topical anesthetics, ganciclovir/valganciclovir for treatment.

Coxsackievirus Infection

  • Affects primarily children under 10, often presents as hand, foot, and mouth disease (HFM).
  • Transmitted via fecal-oral route.
  • Oral lesions: vesicular, become ulcers.

Herpangina

  • Associated with Coxsackievirus, affects children under 10.
  • Symptoms include high fever, sore throat, vesicular lesions in the oropharynx.

Necrotizing Ulcerative Gingivitis & Periodontitis

  • Associated with immune suppression, poor hygiene, and local trauma.
  • Characterized by painful gingiva and ulceration; possible systemic complications.

Erythema Multiforme (EM)

  • An acute inflammatory condition, potentially linked to infections or drugs.
  • Oral lesions can vary from mild to severe ulcers, often affecting the lips and buccal mucosa.

Stevens-Johnson Syndrome & Toxic Epidermal Necrolysis

  • Rare, severe reactions to medications.
  • Characterized by extensive oral ulceration, with high mortality rates for TEN.

Plasma Cell Stomatitis (PCS)

  • Hypersensitivity reaction to contactants, presenting with erythema, ulcers, and edema.
  • Diagnosis often requires biopsy to identify plasma cell infiltration.