Persistent Oral Ulcers and Sore Throat

Abstract

REPORT OF A CASE A 75-year-old woman presented with a 6-month history of a sore throat and subsequent development of blisters and ulcerations of the oral mucosa. Two months before, she had noted the appearance of blisters and bullae on the upper trunk and left arm. Treatment with topical fluocinonide gel (0.05% ) by her family physician had no effect on these lesions. Erosions of the nasal mucosa then began to develop. She denied fever and chills but did note an 11.25-kg (25-lb) weight loss over this 6-month period. Other particulars of her medical and family history were noncontributory. Physical examination revealed an elderly woman who appeared chronically ill. Multiple crusted lesions on her scalp with associated alopecia were noted (Fig 1). On the medial canthus was one erosive erythematous lesion with crusting, and multiple shallow ulcers were present around both nares. Erosions were also noted throughout the pharynx, hard and