Case 32-2008 -- A 10-Year-Old Girl with Recurrent Oral Lesions and Cutaneous Bullae

doi:10.1056/NEJMcpc0805312

Volume 359:1718-1724		October 16, 2008		Number 16

Case 32-2008 — A 10-Year-Old Girl with Recurrent Oral Lesions and Cutaneous Bullae

James G.H. Dinulos, M.D., and Artur Zembowicz, M.D.

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Presentation of Case

Dr. Melissa M. Burnett (Pediatric Dermatology): A 10.8-year-oldgirl was seen in the Pediatric Dermatology Clinic of this hospitalbecause of recurrent oral ulcers and cutaneous bullae.

The patient was well until 2 years of age, when white lesionsdeveloped in the mouth that were followed by vesicles and bullaeon the dorsal and plantar surfaces of the feet and, to a lesserdegree, on the knees and hands. The white lesions on the buccalmucosa became ulcerated and painful; the other lesions wereoccasionally painful and pruritic. The lesions lasted 4 daysto 2 weeks. Similar lesions recurred intermittently . . . [Full Text of this Article]

Differential Diagnosis

Epidermolysis Bullosa

Contact Dermatitis

Pompholyx

Recurrent Erythema Multiforme

Behçet's Disease

Gastrointestinal Disorders

Acrodermatitis Enteropathica

Clinical Diagnosis

Dr. James G.H. Dinulos's Diagnosis

Pathological Discussion

Anatomical Diagnosis

Source Information

From the Departments of Medicine and Pediatrics, Dartmouth–Hitchcock Medical Center, Lebanon, NH (J.G.H.D.); the Departments of Medicine and Pediatrics, Dartmouth Medical School, Hanover, NH (J.G.H.D.); and the Department of Pathology, Massachusetts General Hospital, and the Department of Pathology, Harvard Medical School (A.Z.) — both in Boston.