Giant aphthae

Abstract

Aphthae are single or multiple small painful ulcers, preceded by a burning sensation, with a yellow background surrounded by a non-indurated red border, healing usually in 8-10 days. They usually affect the buccal mucosa, but sometimes they are bipolar (orogenital) with possible variants: deep aphthae >1cm, herpetiform aphthae measuring 1-3mm, giants aphthae, miliary aphthae. Benign idiopathic aphtosis is frequent, reactivated by contact with some food (citrus fruit, tomato, walnuts, gruyère). Some drugs can cause aphthoid ulcerations: nonsteroidal anti-inflammatory drugs, nicorandil, alendronate sodium, betablockers, opiate analgesics, savarine, sirolimus, anti-EGFR. Complex aphtosis (at least 3 recurrent episodes of ulcers) can lead to enterocolopathy or celiac disease, sometimes revealing martial or vitamin deficiency (folates, vitamin B12). Bipolar aphtosis is strongly suggestive of Behçet's disease. We report the case of a 40-year old man presenting for increase in left thigh volume. Ultrasound showed aneurysm of the femoral artery. Clinical examination objectified giant aphthous ulcer in the tongue. Patient interview revealed recurrent genital and buccal aphthae and ophthalmologic examination showed posterior uveitis. The diagnosis of Behçet's disease was retained and emergency bolus dose of corticosteroids with immunosuppressants (cyclophosphamide) was started.