Pediatric emergency medicine trisk 256

Group A streptococcal pharyngitis can present with a characteristic “strawberry
tongue,” with hypertrophic red papillae on a thick white coat, tonsillar hyperemia,
hypertrophy, and exudate, and palatal petechiae ( Fig. 52.2 ). If an erythematous,
papular “sandpaper” rash is present, most commonly on the trunk, the condition is
termed scarlet fever.
Ludwig angina is a rapidly progressive cellulitis of the sublingual and
submandibular space, resulting in skin erythema, pitting edema, trismus, and high
fever, with the potential for airway compromise if inadequately treated. Treatment
includes surgical drainage and broad spectrum antibiotics.
Koplik spots are pinpoint white macules on markedly erythematous mucous
membranes, occurring with cough, coryza, conjunctivitis, and fever during the
prodrome of measles. They generally resolve before the characteristic rash
occurs. Varicella lesions occurring in the mouth are self-limited, painful vesicles
on an erythematous base, sometimes found unroofed. Pain may lead to reluctance
to swallow.


TABLE 52.1
DIFFERENTIAL DIAGNOSIS OF ORAL LESIONS


Congenital oral lesions
Epstein pearls
Epithelial pearls
Bohn nodules
Dental lamina cysts
Natal teeth
Ankyloglossia
Epulis (gum boil)
Lymphatic malformation
Hemangioma

Vascular malformation
Dermoid/epidermoid cyst
Foregut duplication cyst
White sponge nevus
Infectious oral lesions
Candidiasis
Median rhomboid glossitis
Herpes simplex
Gingivostomatitis—primary
Labialis—recurrent (cold sores)
Hand–foot–mouth disease
Herpangina
Scarlet fever
Streptococcal pharyngitis
Ludwig angina
Measles
Varicella
Human immunodeficiency virus infection
Dental–alveolar abscess
Pericoronitis
Acute necrotizing ulcerative gingivitis (trench mouth)
Noma
Syphilis
Acquired (secondary)
Congenital


Hairy tongue
Tumorous oral lesions
Eruption cyst

Odontogenic cyst
Oral papilloma
Peripheral ossifying fibroma
Peripheral giant cell granuloma
Desmoid
Mucocele
Ranula
Pyogenic granuloma
Lingual thyroid tissue
Fibroma
Melanotic neuroectodermal tumor of infancy
Juvenile xanthogranuloma
Neurofibroma
Rhabdomyosarcoma
Oral lesions associated with systemic disease
Stevens–Johnson syndrome
Erythema multiforme
Mycoplasma-induced rash and mucositis
Toxic shock syndrome
Mucositis
Palatal mucormycosis
Kawasaki disease
Crohn disease
Behỗet syndrome
Contusions (consider bleeding disorders or child abuse)
Epidermolysis bullosa
Angular cheilitis
Parulis
Miscellaneous oral lesions
Aphthous stomatitis (including as part of PFAPA)

Erythema migrans (geographic tongue)
Frictional keratosis