Differential Diagnosis for Severe Stomatitis
Single Most Likely Diagnosis
- Aphthous Stomatitis: This is the most common cause of severe stomatitis, characterized by recurrent, painful ulcers in the oral cavity. The diagnosis is often clinical, based on the appearance of the ulcers and the patient's history.
Other Likely Diagnoses
- Herpes Simplex Virus (HSV) Infection: HSV can cause severe stomatitis, especially in immunocompromised individuals. The presence of vesicles or ulcers, along with systemic symptoms like fever, supports this diagnosis.
- Hand, Foot, and Mouth Disease (HFMD): Caused by viruses like Coxsackievirus A, HFMD can lead to severe stomatitis, particularly in children. The diagnosis is based on the characteristic rash on the hands and feet, along with oral ulcers.
- Stomatitis due to Medications or Chemicals: Certain medications, such as chemotherapy agents, and chemicals can cause stomatitis. A thorough history of medication use or chemical exposure is essential for this diagnosis.
Do Not Miss Diagnoses
- Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN): These are life-threatening conditions that can present with severe stomatitis, along with skin and mucous membrane involvement. Prompt recognition and treatment are crucial to prevent mortality.
- Leukemia or Lymphoma: In rare cases, severe stomatitis can be a presenting symptom of hematological malignancies. A high index of suspicion is necessary, especially in patients with systemic symptoms or unexplained weight loss.
- Autoimmune Disorders (e.g., Pemphigus, Lupus): Certain autoimmune conditions can cause severe stomatitis. These diagnoses should be considered, especially if there are other systemic symptoms or a history of autoimmune disease.
Rare Diagnoses
- Erythema Multiforme: A rare condition characterized by target lesions on the skin and mucous membranes, which can include the oral cavity.
- Graft-Versus-Host Disease (GVHD): In patients who have undergone bone marrow or stem cell transplantation, GVHD can cause severe stomatitis, among other symptoms.
- Behçet's Disease: A rare autoimmune disorder that can cause recurrent oral ulcers, along with genital ulcers and ocular inflammation.