Recurrent Severe Aphthous Stomatitis in Young Adult Male

Case at a Glance

A 21-year-old healthy male presents with recurrent episodes of severe aphthous stomatitis characterized by multiple painful ulcerations and white patches throughout the oral cavity, significantly impacting his ability to eat, drink, and perform basic oral functions.

Patient's Story

The patient experiences severe outbreaks of oral ulcerations 2-3 times annually. He is a non-smoker, non-drinker, weighing 180 lbs with no significant medical history. The most severe episode occurred in December 2021 during a COVID-19 infection, when he developed extensive oral ulcerations with severe lip swelling, requiring hospitalization for IV fluid replacement due to inability to maintain oral intake. Since then, ulcerations typically coincide with systemic illness but occasionally occur during periods of apparent good health. Most recently, following a vacation, he developed approximately eight canker sores causing significant pain and functional impairment.

Initial Assessment

Physical examination reveals multiple aphthous ulcers distributed throughout the oral cavity, appearing as painful, well-demarcated lesions with white or yellow centers surrounded by erythematous borders. The patient demonstrates obvious discomfort with mouth opening and swallowing attempts. No systemic signs of illness are present during the current episode.

The Diagnostic Journey

The patient has consulted multiple healthcare providers without receiving a definitive diagnosis or effective treatment plan. The recurrent nature, severity, and association with systemic illness suggest a diagnosis of recurrent aphthous stomatitis, though the extreme severity raises consideration for underlying immunologic factors or nutritional deficiencies that have not been adequately investigated.

Final Diagnosis

Recurrent Severe Aphthous Stomatitis (Major Aphthous Ulcers)

Treatment Plan

Topical corticosteroid therapy with high-potency agents such as clobetasol gel or triamcinolone acetonide paste for acute management. For patients without prescription access, over-the-counter hydrocortisone cream may provide some relief. Pain management with topical anesthetics and systemic analgesics as needed. Nutritional assessment to rule out deficiencies in B12, folate, iron, or zinc. Consideration of prophylactic therapy for recurrent episodes.

Outcome and Follow-up

Patient education regarding trigger avoidance and early intervention strategies. Follow-up planned to monitor treatment response and assess need for systemic immunosuppressive therapy if topical treatments prove inadequate. Referral to oral medicine specialist may be considered for refractory cases.