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Severe Recurrent Herpetic Gingivostomatitis in an Adolescent Immunosuppressed Patient on Adalimumab and Mycophenolate Mofetil: A Case Report
Presenter:
Chaw-Ning Lee, MD
Authors:
Chaw-Ning Lee, MD1, Aim-On Saengsirinavin, MD2, Negin Yavari, MD2, Frances Andrea Anover, MD2, Zheng Xian Thing, MD2,3, Jia-Horung Hung, MD2, Chew Zhi Rui John3, Dalia El-feky, MD2,5, Osama Elaraby, MD2, Xiaoyan Zhang, MD2, Cigdem Yasar, MD2, Azadeh Mobasserian, MD2, Amir Akhavanrezayat, MD2, Ngoc Trong Tuong Than, MD2, Quan Dong Nguyen, MD, MSc2
1Department of Dermatology, Stanford University, Palo Alto, CA, USA
2Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
3National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
4National University of Singapore, Yong Loo Lin School of Medicine, Singapore
5Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
Affiliation:
Purpose: To describe the clinical diagnostic challenge of a patient on immunosuppressive therapy with ulcerations of the oral mucosa, after taking nonsteroidal anti-inflammatory drugs (NSAIDs) and amoxicillin/clavulanate for a suspected ear infection.
Methods: Case report and review of the literature.
Observation: An 18-year-old male with an underlying disease of idiopathic chorioretinitis treated with prednisone, adalimumab, and mycophenolate mofetil, presented to the emergency department with ulcers and bleeding of the lip mucosa for the past four days after taking amoxicillin/clavulanate. Clinical features initially mimicked Stevens-Johnson syndrome (SJS), but a definitive diagnosis of herpetic gingivostomatitis was made after thorough evaluation. The patient was successfully treated with antiviral therapy.
Conclusion: This study highlights the clinical presentation, detailed findings, and successful treatment strategy for HSV gingivostomatitis in a patient undergoing immunosuppressive therapy. Herpetic infections, though rare, are a possibility in patients receiving adalimumab and other immunomodulatory therapies, and should be kept in mind for timely treatment.