Differential Diagnosis for an 8-year-old Girl with Oral Lesions
Single Most Likely Diagnosis
- Herpes Simplex Virus (HSV) Infection: This is the most likely diagnosis given the presence of vesicles around the buccal mucosa and lips, accompanied by fever. HSV infections are common in children and can cause herpetic gingivostomatitis, which presents with oral vesicles, ulcers, and fever.
Other Likely Diagnoses
- Hand, Foot, and Mouth Disease (HFMD): Although HFMD typically presents with rashes on the hands and feet, some cases may have only oral lesions. The fever and oral vesicles could be consistent with HFMD, especially if the rash has not yet appeared or is very mild.
- Aphthous Ulcers: These are common in children and can be triggered by fever, stress, or minor oral trauma. However, the presence of vesicles and a high fever makes this diagnosis less likely than HSV.
- Enteroviral Infection: Enteroviruses can cause a range of symptoms including fever and oral lesions, similar to HFMD. The absence of a rash does not rule out an enteroviral infection.
Do Not Miss Diagnoses
- Primary Herpetic Gingivostomatitis with Potential for Herpes Simplex Encephalitis: Although rare, if left untreated, HSV can lead to more severe complications like encephalitis. Early recognition and treatment of HSV infection are crucial to prevent such outcomes.
- Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN): These are severe skin and mucous membrane disorders usually caused by medications or infections. The initial presentation can be similar to other conditions with oral lesions and fever, but SJS/TEN can rapidly progress to involve the skin and eyes, leading to severe morbidity and mortality.
Rare Diagnoses
- Pemphigus Vulgaris: An autoimmune disease that can cause blistering of the skin and mucous membranes. It is rare in children and would be an unusual cause of the symptoms described.
- Behçet's Disease: A form of vasculitis that can cause oral ulcers, among other symptoms. It is rare in children and typically involves other systems, including the eyes and skin.
- Autoimmune Disorders (e.g., Systemic Lupus Erythematosus): These can cause a wide range of symptoms including oral ulcers, but are rare in children and usually involve multiple other symptoms and systems.