Viral Stomatitis with Oral Lesions in Pediatric Patient

Case at a Glance

A 4-year-old male presented with oral mucosal lesions, tongue discomfort, and upper respiratory symptoms following a similar illness pattern in family members, consistent with viral stomatitis.

Patient's Story

The patient's mother reported a sequential viral illness affecting multiple family members. The youngest sibling initially developed oral lesions resembling canker sores with one day of fever. The mother subsequently experienced high fever (39°C), malaise, worsening cough, nasal congestion, and a sandpaper-like tongue sensation. The 4-year-old patient then developed tongue soreness with visible changes to the oral mucosa, including enlarged papillae giving a bumpy appearance to the tongue and roof of the mouth near the throat. He also presented with mild rhinorrhea but remained afebrile with no other systemic symptoms.

Initial Assessment

Physical examination revealed enlarged fungiform papillae on the tongue surface creating a bumpy texture, mucosal changes on the hard palate near the posterior pharynx, and mild nasal congestion. No fever was documented at presentation. No cutaneous rash was observed on hands, feet, or other body surfaces.

The Diagnostic Journey

The clinical presentation and family history suggested a viral etiology. Differential diagnoses considered included hand, foot, and mouth disease (HFMD), other enteroviral infections, and streptococcal pharyngitis. The absence of fever and the pattern of family transmission favored a viral cause over bacterial infection. The lack of characteristic vesicular lesions on extremities did not rule out HFMD, as oral-only presentations are common.

Final Diagnosis

Viral stomatitis, likely secondary to enteroviral infection, possibly hand, foot, and mouth disease variant with isolated oral manifestations.

Treatment Plan

Supportive care was recommended including adequate hydration, soft diet to minimize oral discomfort, and symptom management. Parents were advised to monitor for signs of dehydration or respiratory distress. No antiviral therapy or antibiotics were indicated.

Outcome and Follow-up

Patient was scheduled for routine follow-up if symptoms persisted or worsened. Parents were educated about the self-limiting nature of viral illnesses and advised to seek immediate care if breathing difficulties or signs of dehydration developed. The family was counseled on infection control measures to prevent further transmission.