A Rare Severe Course of Aphthous Pharyngostomatitis

A 48-year-old man was referred from the gastroenterology department to the ENT clinic because of 3- to 4-week history of pain-related aphagia . The patient had refractory ulcerative colitis for which he was receiving multimodal immunosuppressive treatment. Clinical examination revealed extended areas of deep, fibrin-covered ulceration of the gums, the floor of the mouth, and the oral vestibule. Human herpes simplex virus type 1 (HSV 1) was found in crusted cutaneous erosion.

The patient’s medical history, together with the clinical and paraclinical findings, pointed to the diagnosis of Pospischill – Feyrter aphthoid. This very rare but extremely severe form of herpetic gingivostomatitis typically occurs in children, less commonly in adults, with greatly weakened immune defenses, e.g., following chemotherapy or organ transplantation. A characteristic finding is progressive marginal expansion of the efflorescences. The treatment comprises intravenous aciclovir with symptomatic lidocaine mouthwash, systemic analgesia, and rehydration. In this case the patient’s odynophagia regressed only after 3 weeks of antiviral treatment.

Dr. med. Martin Sorge, Prof. Dr. med. Andreas Dietz, University Hospital Leipzig, Clinic and Polyclinic for ENT Medicine, martin.sorge@medizin.uni-leipzig.de

Dr. med. Dr. med. dent. Stephan Meyer, Universitätsklinikum Leipzig, Clinic for Oral, Maxillofacial and Plastic Facial Surgery

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Sorge M, Meyer S, Dietz A: A rare severe course of aphthous pharyngostomatitis. Dtsch Arztebl Int 2019; 116: 252. DOI: 10.3238 / arztebl.2019.0252a

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