3 Patients with inflammatory bowel disease, in particular Crohn's disease, may present with associated mouth ulcerations. Lupus erythematosus, bullous pemphigoid and pemphigus vulgaris are other diseases that may involve ulceration of the mouth. In all of these conditions, the associated symptoms should be elicited to make a differentiation from benign recurrent aphthae. Herpes stomatitis, found primarily on the alveolar mucosa. Tzank stain of a lesion scraping revealed inclusion-bearing giant cells.
Cyclic neutropenia is associated with mouth ulcers during neutropenic periods.
2 Fever may also be a presenting symptom during these periods. Consideration may be given to blood count measurement if fever and mouth ulcers regularly occur together. Finally, a neoplasm such as squamous cell carcinoma must be ruled out when evaluating patients with persistent, nonhealing mouth ulceration. Office punch biopsy or surgical biopsy may help make this distinction. Evaluation of the head and neck for adenopathy is particularly important in this situation.