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Case 3: Aphthous Stomatitis

Author: Christopher Behrens, MD

Case last updated: October 6, 2008

31-year-old HIV-infected man presents with painful sores in his mouth. His medications consist of tenofovir-DF (Viread), lamivudine (Epivir), and efavirenz (Sustiva); his CD4 count is 328 cells/mm3 and his HIV RNA is less than 50 copies/ml. The oral examination shows several moderately sized ulcerated lesions on the tongue and buccal mucosa (Figure 1). He has previously experienced several similar but less severe episodes. A fluorescent antibody and culture for herpes simplex virus are negative and the diagnosis of aphthous stomatitis is made.

Which of the following is TRUE regarding aphthous stomatitis in HIV-infected patients?

A Cytomegalovirus infection has been identified as the cause of aphthous stomatitis.
B Thalidomide (Thalomid) is an effective therapy for aphthous stomatitis.
C The diagnosis of aphthous stomatitis is best made by performing a Gram’s stain and observing multiple gram-positive rods lining the surface of mucosal cells.
D Oral valganciclovir (Valcyte) is an effective therapy for aphthous stomatitis, providing an approximate 85% clinical response rate.
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    Figure 1 - Ulcerated Lesion on Tongue Figure 1