A 13-Year-Old Boy with Pharyngitis, Oral Ulcers, and Dehydration

Abstract

A13-year-old boy with no significant past medical history was admitted to our institution with pharyngitis, oral ulcers, and dehydration. He was well until 8 days prior to admission when he developed a fever to 103o F and pharyngitis. He was seen by his primary care physician, who ordered a rapid strep test and throat culture, both of which were negative, so symptomatic care was recommended. Four days prior to admission the patient developed ulcers on the inside of his mouth and lips. He was seen again by his primary care physician and started on antiviral medication and ibuprofen with hydrocodone, and a herpes simplex virus–polymerase chain reaction test was ordered. Mouth pain became so severe that the patient was unable to remain adequately hydrated. He was admitted to the hospital for pain control, intravenous fluids, and further work-up. In the 2 days prior to presentation to the hospital, he developed painful lesions on the glans of his penis. Recent medication use included NyQuil (Vicks), Theraflu (Novartis), Famvir (Novartis) and Vicoprofen (Abbott). The patient denied any history of sexual activity or Leanne W. Trapp, MD, is a Resident in Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, University of Chicago. Steven J. Schrantz, MD, Department of Medicine, Division of Infectious Diseases NorthShore University HealthSystem; and Clinical Assistant Professor, University of Chicago Pritzker School of Medicine. Monica A. Joseph-Griffin, MD, is Clinical Assistant Professor, Department of Pediatrics, NorthShore University HealthSystem; and Clinical Assistant Professor, Pritzker School of Medicine, University of Chicago. Joseph R. Hageman, MD, is Emeritus Attending Physician, Department of Pediatrics, NorthShore University HealthSystem; and Senior Clinician Educator, Pritzker School of Medicine, University of Chicago. Shoshana E. Waskow, MD, is an independent practitioner, Pediatric Associates of the NorthShore. Address correspondence to: Leanne W. Trapp, MD, Comer Children’s Hospital, 5721 S. Maryland Avenue, Chicago, IL 60637; fax: 773-834-0748; email: Leanne.trapp@uchospitals.edu. Disclosure: The authors have no relevant financial relationships to disclose. doi: 10.3928/00904481-20130326-06 Figure 1. Cracked, scabbed lips with ulcerations. Al l i m ag es c ou rte sy o f L ea nn e W . T ra pp , M D.