Differential Diagnosis for Burning Mouth Sensation
The patient presents with a continued burning sensation in his mouth, despite some improvement with nystatin treatment. The following differential diagnoses are considered:
- Single most likely diagnosis
- Oral candidiasis (thrush): The patient's initial improvement with nystatin, an antifungal medication, suggests that candidiasis is a likely cause of his symptoms. The white coating on his tongue is also consistent with this diagnosis.
- Other Likely diagnoses
- Dry mouth (xerostomia): The patient's initial presentation with dry mouth and allergy symptoms, which improved but left him with a burning sensation, suggests that dry mouth may be contributing to his symptoms.
- Burning mouth syndrome (BMS): This condition is characterized by a burning sensation in the mouth without an identifiable cause. The patient's continued symptoms despite treatment for candidiasis make BMS a possible diagnosis.
- Oral lichen planus: This chronic inflammatory condition can cause a burning sensation in the mouth, as well as white patches on the tongue and mucous membranes.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Oral cancer: Although unlikely, oral cancer can cause a burning sensation in the mouth and must be ruled out, especially in older adults or those with a history of tobacco use.
- Sjögren's syndrome: This autoimmune disorder can cause dry mouth and a burning sensation, and is associated with an increased risk of lymphoma.
- Rare diagnoses
- Pemphigus: A rare autoimmune disorder that can cause blisters and a burning sensation in the mouth.
- Geographic tongue: A rare condition characterized by patches on the tongue that can cause a burning sensation.
- Nutritional deficiencies (e.g., vitamin B12 deficiency): Certain nutritional deficiencies can cause a burning sensation in the mouth, although this is relatively rare.