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Controversies in verruco papillary lesions of the oral cavity-A systematic review

Pilana Vithanage Kalani Shihanika H, Nadisha P, Bogahawatte Samarakoon Mudiyanselage Samadarani S, Ruwan Duminda J, Sriyani P, Tilakaratne WM

Oral Dis, 2023 Nov;29(8):3049-3060.
PMID: 35801381 DOI: 10.1111/odi.14306

INTRODUCTION: Verruco papillary lesions (VPL) in the oral cavity encompass a spectrum of lesions starting from benign, potentially malignant to entirely malignant tumors. Much of the controversies in these entities occur due to lack of consensus on the disease characteristics and the management. This systematic review was conducted to identify and describe different lesions categorized as VPL in the oral cavity and their association with malignancy.
METHODS: An electronic literature search was conducted in MEDLINE (via PubMed), Scopus, LILAC, IMSEAR, and CENTRAL databases, which retrieved a total of 1020 abstracts. These abstracts were managed through Rayyan and Mendeley software, and only 28 studies with high quality were included in the systematic review.
RESULTS: Studies were published from 1992 to 2021. From the extracted data, nine different entities under the umbrella term VPL were identified associated with malignancy. We describe the clinical and histopathological characteristics of these and propose a uniform framework for nomenclature.
CONCLUSIONS: Lack of well-planned research with adequate follow-up duration and inadequate quality standards are major barriers for the lack of evidence. The use of uniform nomenclature, as proposed in this study, and research at the molecular level will greatly reduce the controversies in understanding oral VPL associated with malignancy.

Matched MeSH terms: Oral Ulcer*
Fulltext Traumatic ulcerative granuloma with stromal eosinophilia - Mystery of pathogenesis revisited

Sarangarajan R, Vaishnavi Vedam VK, Sivadas G, Sarangarajan A, Meera S

J Pharm Bioallied Sci, 2015 Aug;7(Suppl 2):S420-3.
PMID: 26538890 DOI: 10.4103/0975-7406.163474

Oral ulcers are a common symptom in clinical practice. Among various causative factors, different types of ulcers in oral cavity exist. Among this, traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) appears to be quite neglected by the clinicians due to the limited knowledge and awareness. On reviewing with a detailed approach to titles and abstracts of articles eliminating duplicates, 40 relevant articles were considered. Randomized studies, review articles, case reports and abstracts were included while conference papers and posters were excluded. Of importance, TUGSE cases been reported only to a minimal extent in the literature. Lack of its awareness tends to lead clinicians to a misconception of cancer. Thus, this particular lesion needs to be differentiated from other malignant lesions to provide a proper mode of treatment. The present article reviews various aspects of the TUGSE with emphasis on the clinical manifestation, pathogenesis, histological, and immunohistochemical study. This study provides the clinician contemporaries, a humble expansion to their knowledge of the disease, based on the searched literature, enabling a more comprehensive management of this rare occurrence.

Matched MeSH terms: Oral Ulcer
Fulltext Uvulo-palatoglossal junctional ulcers--an early clinical sign of exanthem subitum due to human herpesvirus 6

Chua KB, Lam SK, Sazaly AB, Lim ST, Paranjothy M

Med J Malaysia, 1999 Mar;54(1):32-6.
PMID: 10972002

A provisional clinical diagnosis of exanthem subitum was made in six febrile infants seen in the Paediatric Unit of Assunta Hospital, Petaling Jaya, Malaysia with uvulo-palatoglossal junctional ulcers prior to the eruption of maculopapular rash. On follow-up, all six infants developed maculopapular rash with the subsidence of fever at the end of the fourth febrile day. Human herpesvirus 6 was isolated from the peripheral blood mononuclear cells during the acute phase of the illness and HHV 6 specific genome was also detected in these cells by nested polymerase chain reaction. All the six infants showed seroconversion for both specific IgG and IgM to the isolated virus. This study suggests that the presence of uvulo-palatoglossal junctional ulcers could be a useful early clinical sign of exanthem subitum due to human herpesvirus 6.

Matched MeSH terms: Oral Ulcer/etiology*; Oral Ulcer/virology
Fulltext The prevalence of oro-facial pain and discomfort among 16-year old students In Kelantan - a pilot study

Jaafar, N., Saub, R., Razak, I.A.

Ann Dent, 1997;4(1):9-12.
MyJurnal

A pilot study was conducted on 135 sixteen-year-old students from three rural schools in Kelantan to establish the prevalence of orofacial pain and discomfort. About 44% reported to have experienced some oro-facial pain in the preceding four weeks. About 27% of those with pain, still experienced the pain at the time of clinical examination but only 8% have consulted professional help. Most of the pain encountered were only mild or moderate in nature. Only 7% and 10% respectively, reported that the pain affected their sleep and concentration to study. The main cause was toothache and sensitivity. The prevalence of discomfort was 22%, the most common causes being recurrent oral ulcers and bleeding gums. The impacts of orofacial pain was mainly manifested at the personal level, and very few affecting social functioning. However, untreated decay and missing teeth were very low (mean DT 0.47, mean MT 0.27), while filled teeth (mean Ff 2.9) was the main component of the DMFf (mean 3.66, sd ± 2.6). Severe periodontal disease and the prevalence of traumatised teeth was not a major public health problem. The high prevalence of pain merit further research. Therefore a larger study involving other age-groups in other states is planned.

Matched MeSH terms: Oral Ulcer
Fulltext Plunging epidermoid cyst of the floor of the mouth mimicking a ranula

Anusha Balasubramanian, Irfan Mohamad, Purushotman Ramasamy, Avatar Singh Mohan Singh, Lina Ling Chooi, Ferdinand Jesudian Kovilpillai

Malaysian Journal of Medicine and Health Sciences, 2016;12(1):67-69.
MyJurnal

Plunging epidermoid cyst of the floor of mouth is indeed an uncommon entity. A 34-year old Malay
gentleman had presented to our centre with a floor of mouth lesion that extended into the submental
region. Clinical findings and imaging studies pointed towards the impression of a plunging ranula.
Histopathological examination of a completely excised mass via intraoral approach, confirmed the
diagnosis of an epidermoid cyst. He was well on follow up with no subsequent recurrence. We discuss
the nature of epidermoid cyst and its surgical management.

Matched MeSH terms: Oral Ulcer
Fulltext The evaluation of Streptococcus mutans content of saliva in patients with recurrent oral ulceration

Al-Ahmad, Basma Ezzat Mustafa, Muhannad Ali Kashmoola, Nur Aini Zakaria

International Medical Journal Malaysia, 2017;16(21):14-14.
MyJurnal

Recurrent oral ulcer is a chronic inflammatory condition characterized by mucosa
ulceration, which was believed to have bacterial etiology. Streptococcus mutans is one of the
bacteria which have been implicated in this case; it is gram-positive bacteria that reside in the
biofilms on the tooth surfaces. The aim of this study was to evaluate Streptococcus mutans content
in saliva of recurrent oral ulcer patients and its role as a prognostic factor. (Copied from article).

Matched MeSH terms: Oral Ulcer
Oral histoplasmosis presenting as oral ulcer in a non-HIV patient

Rahman MT, Bakar NH, Philip R, Shamsudin AR

Southeast Asian J. Trop. Med. Public Health, 2004 Jun;35(2):388-90.
PMID: 15691142

A 40-year-old man presented with chronic mouth ulcer for the last six months. Histopathological examination of the biopsy from the lesion confirmed a diagnosis of histoplasmosis. Although histoplasmosis commonly manifests in immunocompromized patients, like HIV, the present case was negative for HIV. Histoplasmosis is endemic in certain parts of the world and it is comparatively rare in the South Asian region, particularly Malaysia. Thirty-seven cases of histoplasmosis were reported from Malaysia (Ng and Siar, 1996), between July 1967 and October 1997. Despite the apparent rarity of the disease, clinicians and pathologists should be aware of the possibility of histoplasmosis when cases of oral ulcer are encountered.

Matched MeSH terms: Oral Ulcer*
Fulltext Blended learning for reinforcing dental pharmacology in the clinical years: A qualitative analysis

Eachempati P, Kiran Kumar KS, Sumanth KN

Indian J Pharmacol, 2016 Oct;48(Suppl 1):S25-S28.
PMID: 28031603 DOI: 10.4103/0253-7613.193315

OBJECTIVES: Blended learning has become the method of choice in educational institutions because of its systematic integration of traditional classroom teaching and online components. This study aims to analyze student's reflection regarding blended learning in dental pharmacology.
SUBJECTS AND METHODS: A cross-sectional study was conducted in Faculty of Dentistry, Melaka-Manipal Medical College among 3(rd) and 4(th) year BDS students. A total of 145 dental students, who consented, participate in the study. Students were divided into 14 groups. Nine online sessions followed by nine face-to-face discussions were held. Each session addressed topics related to oral lesions and orofacial pain with pharmacological applications. After each week, students were asked to reflect on blended learning. On completion of 9 weeks, reflections were collected and analyzed.
STATISTICAL ANALYSIS: Qualitative analysis was done using thematic analysis model suggested by Braun and Clarke.
RESULTS: The four main themes were identified, namely, merits of blended learning, skill in writing prescription for oral diseases, dosages of drugs, and identification of strengths and weakness. In general, the participants had a positive feedback regarding blended learning. Students felt more confident in drug selection and prescription writing. They could recollect the doses better after the online and face-to-face sessions. Most interestingly, the students reflected that they are able to identify their strength and weakness after the blended learning sessions.
CONCLUSIONS: Blended learning module was successfully implemented for reinforcing dental pharmacology. The results obtained in this study enable us to plan future comparative studies to know the effectiveness of blended learning in dental pharmacology.

Matched MeSH terms: Oral Ulcer/drug therapy
The prevalence of post-extraction complications in an outpatient dental clinic in Kuala Lumpur Malaysia--a retrospective survey

Jaafar N, Nor GM

Singapore Dent J, 2000 Feb;23(1):24-8.
PMID: 11602946

The aim of this retrospective study is to report on the prevalence of post-extraction complications among patients attending the Oral Surgery outpatient clinic of the Faculty of Dentistry, University of Malaya over a 12-month period from January to December, 1992. The prevalence of post-extraction complications which required further treatment was only 3.4% (n = 100), out of a total of 2968 patients who had extraction of one or more permanent teeth. Analysis based on complete clinical reports (n = 79) showed that dry socket accounted for nine out of ten cases of post-extraction complications. However the aetiology was largely unknown. No obvious association with medical history could be made. Lower teeth were more likely to have complications. The most common teeth associated with dry socket were the molars (76%) and premolars (19%). The most common molars to be affected are the first, followed by the third and lastly the second molars. A brief review of current aetiological factors of dry socket was discussed.

Matched MeSH terms: Oral Ulcer/etiology; Oral Ulcer/epidemiology
Fulltext Sweet's syndrome in Crohn's colitis

Anwar S, Hishamuddin A, Khairul AJ, Shamsul AJ, Razlan H, Said MS

BMJ Case Rep, 2009;2009.
PMID: 21687021 DOI: 10.1136/bcr.01.2009.1438

We would like to report a case involving a 38-year-old woman who presented with knee and ankle swellings 2 weeks prior to admission. There were also multiple painful oral ulcers and a few skin sores on the wrist. She also had associated diarrhoea for 2 weeks. There was also marked loss of weight (6 kg in 2 weeks). Colonoscopy examination showed macroscopic and histopathological findings of Crohn's disease; however, skin histology showed extensive neutrophilic infiltration in the dermis, predominantly in the perivascular region. Her final diagnosis was Sweet's syndrome with Crohn's disease.

Matched MeSH terms: Oral Ulcer
Fulltext Halal & organic mouth-wash: Frankincense essential oil & hydrosol Boswellia Mouth-wash Essential Oil (BOMEO)

Mohammed Sulayman Baree, Mohammed Elwathig Saeed Mirghani, Slimane Hammou Aboulala

Malaysian Journal of Medicine and Health Sciences, 2019;15(108):51-51.
MyJurnal

Introduction: This is a proto-type product which is based on Frankincense essential oil and hydrosol. Methods: Three oleo gum resin species, namely; Boswellia carterii (BC), Boswellia frereana (BF), and Commiphora myrrha (CM) of Burceraceae family were extracted for their essential oil by hydro-distillation. They were screened for their poten-tial of anti-cariogenic activity by in-vitro experimental study of two main bacterial species (Streptococcus mutans and Lactobacillus spp), which are considered the main cause of dental and mouth diseases. Results: Methanol and acetone extracts of the three plants inhibited the growth of the bacteria. However, BF-methanol extract shows the greatest inhibition followed by BC and CM respectively. Hence, the obtained result encourages proceeding further thorough investigation to benefit the positive outcomes of these plant extracts in terms of introducing new potential antimicrobial formulations, such as mouth wash which can be used for mouth cleansing and protection from the diseases such as mouth ulcers, gingivitis, sinusitis, glandular fever and brucellosis as well as dental caries. This result can be converted to Boswellia Mouthwash Essential Oil (BosMEO) and Boswellia Mouthwash Hydrosol (BosMoHy) based products. This new plant extract product can be exploited for further research for its potential used as moth infection natural treatments such as mouth ulcers, gingivitis, sinusitis, glandular fever, brucellosis as well as respi-ratory problem. It is free of synthetic chemicals, organic, natural, plant based, and halal with no major health side effects. Conclusion: Plant-based product which is free from synthetic chemicals and with minimal side effects will satisfy its quality efficiency.

Matched MeSH terms: Oral Ulcer
Fulltext Anti-oral ulcer activity of Ficus Deltoidea leaves extract on animal model

Vivi Noryati Ahmad, Indah Mohd Amin

Pertanika Journal of Science & Technology, 2017;25(103):41-52.
MyJurnal

The purpose of this study is to investigate the effectiveness of Ficus deltoidea (F. deltoidea) as an antioral ulcer on animal models. Adult male Sprague Dawley rats were sedated with Nembutal through intraperitoneal route; oral ulcer models were made by applying 99.5% of glacial acetic acid moistened paper disc on rat buccal mucosa. Four groups of these rats were treated respectively with: no treatment (group 1: negative control); Triamcinolone acetonide (group 2: positive control); 250 mg kg-1 F. deltoidea extract (group 3: experimental); 500 mg kg-1 F. deltoidea extract (group 4: experimental) for 10 consecutive days, respectively. On days 2, 4, 6, 8 and 10, the ulcers size was assessed. Data was analysed statistically by using SPSS. The negative control rats exhibited buccal mucosa injury whereas treatment with F. deltoidea and Triamcinolone acetonide resulted in significantly reduced size of oral ulcer. The percentage of inhibitory area of oral ulcer was more prominent in 500 mg kg-1 F. deltoidea extract than 250 mg kg-1. Meanwhile, in vivo study showed that F. deltoidea extract not toxic up to 1000 mg kg-1. The present findings suggest that F. deltoidea extract effectively accelerates oral ulcer healing process, and could therefore be developed as a therapeutic agent for healing oral ulcer.

Matched MeSH terms: Oral Ulcer
Fulltext Neonatal tooth with Riga-Fide disease affecting breastfeeding: a case report

Jamani NA, Ardini YD, Harun NA

Int Breastfeed J, 2018;13:35.
PMID: 30065775 DOI: 10.1186/s13006-018-0176-7

Background: Neonatal teeth erupt during the neonatal period and natal teeth are the presence of teeth since birth. While rare, natal teeth and neonatal teeth can have a significant impact on breastfeeding. Neonatal teeth are less common, and although its exact etiology is still unknown, it can cause difficulties in breastfeeding to the mother and may eventually lead to discontinuation of breastfeeding. Other associated possible complications include tooth aspiration and sublingual ulceration. This paper was aimed to discuss the clinical features, complications, and management of neonatal tooth, in addition to its impact on breastfeeding and role in sublingual ulcer formation.
Case presentation: We present a baby girl who had a neonatal tooth with sublingual ulceration (Riga-Fede disease), which resulted in a difficulty to breastfeed for the baby and nipple pain to the mother. Following the extraction of the baby's tooth, she immediately continued breastfeeding, and her tongue ulcer healed well.
Conclusion: Extraction of the neonatal tooth promoted rapid healing of oral ulcers and the reestablishment of breastfeeding.

Matched MeSH terms: Oral Ulcer
Fulltext The effect of piper sarmentosum aqueous extract on buccal ulcer healing

Md Ismail, N.H., Nik Mohd Alwi N.A.

JUMMEC, 2019;22(1):13-19.
MyJurnal

Oral ulcer is a lesion with multifactorial causes and occurs worldwide. The lesion usually resolved within 14
days, but the pain may have an impact on the quality of patient’s life. Therefore, having a natural derived
remedy that can reduce healing time would be a great advantage. This study aims to investigate histological
sections of buccal ulcer on rats treated with aqueous extract of Piper sarmentosum (AEPS). Glacial acetic acid
was used to induce buccal ulcer on male Sprague Dawley rats. Control group received normal saline while
the experimental group received AEPS for treatment. On certain days of post-ulcer induction, buccal ulcer
tissue samples were harvested, sectioned and stained with Hematoxylin and Eosin (H&E). Histological slides
were examined for inflammation and scored. The inflammation severity reduced from day 2 to day 12. In the
experimental group there was a statistically significant differences of inflammation score, particularly on day
2 with a score of (2.8 + 0.2). Neutrophils were less in the experimental group and the tissue debris clearance
was faster compared to control group. Full reepithelization was observed on both treated tissue sections on
day 12 with less severe inflammation. Topical application of AEPS is proven to have anti-inflammatory effect
by reducing the number of neutrophils during inflammation phase of oral ulcer healing.

Matched MeSH terms: Oral Ulcer
Fulltext Evaluation of the salivary flow rate and ph in patients with recurrent oral ulcers

Mustafa Al-Ahmad, Basma Ezzat, Sukmasari S., Abdul Jabbar O.

International Medical Journal Malaysia, 2018;17(2):49-56.
MyJurnal

Introductions: Recurrent oral ulcers primarily effect mucosal surfaces and are among the most common chronic inflammatory diseases. Numerous studies to find the aetiopathogenesis have been conducted however the cause still remains unclear. Saliva is of utmostimportance for oral health maintenance. In current study, saliva was used as a diagnostic tool for comparison of salivary flow rate and pH in patients suffering from recurrent oral ulcers and control group. Materials and Methods: Saliva samples taken from 20 recurrent aphthous ulcer patients and 20 control (healthy) patients using a convient sampling method. Drooling method was used to collect unstimulated whole saliva sample. Pre-weighted specimen bottles were used and then weighed after sample collection on a graduated scale where as chair-side pH meter was used to determine the salivary pH. Independent t-test and Pearson’s correlation were performed. A p-value of less than 0.05 was considered statistically significance. Results: Positive correlation was found between the flow rate and pH in recurrent oral ulcer patients. Patients with recurrent oral ulcers had higher flow rate and pH compared to the control group. These effects were exaggerated in female patients with ulcers. Conclusions: Disturbances in salivary flow rate and pH were not significantly associated with recurrent oral ulcers.

Matched MeSH terms: Oral Ulcer
Fulltext The association of uvulo-palatoglossal junctional ulcers with exanthem subitum: a 10-year paediatric outpatient study

Chua KB

Med J Malaysia, 1999 Mar;54(1):58-64.
PMID: 10972006

A 10-year follow-up of children having exanthem subitum (ES) seen in an outpatient paediatric clinic, Kuala Lumpur, Malaysia shows that uvulo-palatoglossal junctional (UPJ) ulcer is a reliable early clinical sign of ES. During this period, 1,977 children (1,086 males, 891 females) had adequate follow-up from the age of 3 months to 24 months old. 897 children (478 males, 419 females) were noted to have UPJ ulcers. Of these 897 children, 855 (459 males, 396 females) presented with the classical clinical features of ES of maculopapular rash following 3 to 4 days of fever. The positive predictive value and the negative predictive value of UPJ ulcers in the clinical diagnosis of ES are 95.3% and 100% respectively. Among the 855 children with clinical features of ES, a provisional diagnosis of ES could be made in 781 children during the pre-eruptive phase by the presence of the UPJ ulcers. The other 74 children already had the rash at the time of consultation at the clinic. The peak age of occurrence of ES was 6 months old with 98.2% of the total cases of ES seen between the age of 4 and 12 months. There was no significant gender difference in the incidence of ES nor any seasonal variation. Mild to moderate diarrhoea was the other commonly associated clinical feature which usually presented from the third febrile day onwards.
Study site: Paediatric clinic, Assunta Hospital, Petaling Jaya, Selangor, Malaysia

Matched MeSH terms: Oral Ulcer/etiology*
Fulltext Painful oral ulcers with hydroxyurea therapy

Norhaya MR, Cheong SK, Ainoon O, Hamidah NH

Singapore Med J, 1997 Jul;38(7):283-4.
PMID: 9339092

Five patients treated with hydroxyurea for various haematological malignancies developed multiple painful oral ulcers. Their neutrophil counts were either normal or elevated. The ulcers disappeared with cessation of hydroxyurea. Oral ulcers recurred when hydroxyurea was resumed in one of the patients. As the patients were unable to tolerate this painful side effect, hydroxyurea had to be discontinued. Appearance of painful oral ulceration seems to be independent of dosing rate or total cumulative dose of hydroxyurea.

Matched MeSH terms: Oral Ulcer/chemically induced*
Fulltext Deaths of children during an outbreak of hand, foot, and mouth disease in Sarawak, Malaysia: clinical and pathological characteristics of the disease. For the Outbreak Study Group

Chan LG, Parashar UD, Lye MS, Ong FG, Zaki SR, Alexander JP, et al.

Clin Infect Dis, 2000 Sep;31(3):678-83.
PMID: 11017815

From April through June 1997, 29 previously healthy children aged <6 years (median, 1.5 years) in Sarawak, Malaysia, died of rapidly progressive cardiorespiratory failure during an outbreak of hand, foot, and mouth disease caused primarily by enterovirus 71 (EV71). The case children were hospitalized after a short illness (median duration, 2 days) that usually included fever (in 100% of case children), oral ulcers (66%), and extremity rashes (62%). The illness rapidly progressed to include seizures (28%), flaccid limb weakness (17%), or cardiopulmonary symptoms (of 24 children, 17 had chest radiographs showing pulmonary edema, and 24 had echocardiograms showing left ventricular dysfunction), resulting in cardiopulmonary arrest soon after hospitalization (median time, 9 h). Cardiac tissue from 10 patients showed normal myocardium, but central nervous system tissue from 5 patients showed inflammatory changes. Brain-stem specimens from 2 patients were available, and both specimens showed extensive neuronal degeneration, inflammation, and necrosis, suggesting that a central nervous system infection was responsible for the disease, with the cardiopulmonary dysfunction being neurogenic in origin. EV71 and possibly an adenovirus, other enteroviruses, or unknown cofactors are likely responsible for this rapidly fatal disease.

Matched MeSH terms: Oral Ulcer/etiology
Fulltext ANA negative (Ro) lupus erythematosus with multiple major organ involvement: a case report

Che Maraina CH, Kamaliah MD, Ishak M

Asian Pac J Allergy Immunol, 2002 Dec;20(4):279-82.
PMID: 12744629

Anti-nuclear antibody (ANA) negative systemic lupus erythematosus (SLE) occurs in about 4-13% of SLE cases. A small group of ANA negative SLE patients with positive anti-Ro antibodies usually present with typical vasculitic skin lesions which can be associated with photosensitivity, renal disease, congenital heart block or neonatal lupus. We present a case of a persistently ANA negative patient who presented with joint pain, rashes, mouth ulcer and alopecia. Clinical diagnosis of systemic lupus erythematosus was made even though ANA was negative. She was started on steroids and went into remission. Later, she developed several episodes of convulsions associated with fever and prominent vasculitic lesions. The patient was also found to have microscopic hematuria, proteinuria, anemia and thrombocytopenia. Renal biopsy showed lupus nephritis class 1B. Due to the prominent skin lesions, we performed anti-extractable nuclear antigens (ENA) antibodies test and anti-Ro turned out to be positive. The final diagnosis was ANA negative SLE (Ro lupus) with cutaneous, renal, musculoskeletal, hematological and cerebral Involvement.

Matched MeSH terms: Oral Ulcer/etiology
The predictive value of uvulo-palatoglossal junctional ulcers as an early clinical sign of exanthem subitum due to human herpesvirus 6

Chua KB, Lam SK, AbuBakar S, Lim ST, Paranjothy M, Koh MT, et al.

J Clin Virol, 2000 Aug;17(2):83-90.
PMID: 10942088

BACKGROUND: The clinical sign of uvulo-palatoglossal junctional (UPJ) ulcers was first noted in 1983 in a 5.5-month-old baby with exanthem subitum (ES). An earlier prospective clinical study showed that there was a strong association of UPJ ulcers and occurrence of ES with a positive predictive value of 95.3% and negative predictive value of 100%.
OBJECTIVE: To determine the value of uvulo-palatoglossal junctional (UPJ) ulcers as an early clinical sign of exanthem subitum (ES) due to human herpesvirus 6 (HHV 6) infection.
STUDY DESIGN: A case-control study of 20 febrile children with UPJ ulcers versus 26 febrile children without UPJ ulcers. These children were followed up for any development of ES and investigated for human herpesvirus 6 (HHV 6) as the causative agents of the febrile episodes.
RESULTS: In this study, 20 out of 46 febrile children aged 3 months to 3 years with UPJ ulcers were virologically and/or serologically confirmed to be due to primary HHV 6 infection. The rest of the 26 children without ulcers did not have HHV 6 infection. Of the 20 children with UPJ ulcers, only 17 of the 19 children with adequate follow-up till subsidence of fever developed ES. None of the 26 children without UPJ ulcers developed ES.
CONCLUSION: Statistically, there was a significant association of UPJ ulcers as an early sign of ES with a positive predictive value of 89.5% and negative predictive value of 100%. This finding also suggests that the presence of UPJ ulcers is a useful pathognomic clinical sign of symptomatic primary HHV 6 infection.

Matched MeSH terms: Oral Ulcer/virology*

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