18. Oral ulceration

A 36-year-old married woman presented for evaluation of three painful chronic ulcers (>1 month duration). Similar oral lesions had been recorded many times in the past, with the first episode reported at 3 months of age. These current ulcers presented after she had a staphylococcal skin infection but were not associated with lymphadenopathy, fever or other general symptomatology. Her medical history was otherwise clear apart from occasional skin and respiratory infections since childhood, and she was on no medication. The patient was only an occasional smoker, non-drinker and none of her family has a history of similar oral lesions.

Extra-oral examination revealed no lesions and no cervical lymphadenopathy.

Oral examination revealed chronic periodontitis and caries in most of her teeth, despite her good oral hygiene. She had one superficial ulcer in the upper right alveolar mucosa, another on the right buccal mucosa and a third ulcer, which was ovoid and deep with well-defined but not erythematous margins, on her tongue dorsum (Figure 1).