eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Aphthous Ulcers: Differential Diagnoses & Workup

Author: Michael C Plewa, MD, Research Coordinator, Consulting Staff, Department of Emergency Medicine, Lucas County Emergency Physicians, Inc, and Saint Vincent Mercy Medical Center
Contributor Information and Disclosures

Updated: May 12, 2009

Differential Diagnoses

Arthritis, Conjunctivitis, Urethritis Syndrome
Systemic Lupus Erythematosus
Crohn Disease
T-Cell Disorders
Herpes Simplex Virus Infection
Varicella
Herpesvirus 6 Infection
Zoster
Human Immunodeficiency Virus Infection
Sprue
Syphilis

Other Problems to Be Considered

Chemical burns
Celiac disease
Coxsackievirus infection (ie, hand-foot-and-mouth disease and herpangina) - Vesicular lesion and fever possible
Cyclic neutropenia - Recurrent infections
Food allergy/hypersensitivity
Histoplasmosis
Lichen planus - Wickham striae or characteristic rash
Mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome
Necrotizing ulcerative gingivostomatitis (Vincent stomatitis, trench mouth) - Halitosis, gingival bleeding, exudate, or necrosis
Pemphigus vulgaris
Periodic fever, aphthous pharyngitis, and adenopathy (PFAPA) syndrome
Squamous cell carcinoma - Painless persistent lesion in older persons
Sutton disease (periadenitis mucosa necrotica recurrens)
Sweet syndrome - Triad of neutropenia, fever, and rash
Thiamine deficiency

Workup

Laboratory Studies

  • The diagnosis of aphthous ulcers (canker sores) is usually based on the history and clinical presentation. No laboratory procedures are available for definitive diagnosis.
    • In patients with severe recurrent aphthous ulcers (RAUs), or canker sores, the clinical picture should guide laboratory testing. CBC count, a chemistry panel, and nutritional workup may be necessary.
    • Patients with suspected malabsorption or a nutritional deficiency should undergo immediate screening. Consider screening in patients presenting with a history of recurrent aphthous ulcers (canker sores) lasting 6 months or longer.
  • CBC counts are usually in the reference range in patients with recurrent aphthous ulcers (canker sores). Findings of neutropenia suggest Sweet syndrome or cyclic neutropenia; findings of leukocytosis suggest periodic fever, aphthous pharyngitis, and adenopathy (PFAPA) syndrome.
  • Serum iron levels may be low with recurrent aphthous ulcers (canker sores).
  • If a patient is dehydrated and catabolic, urinalysis may reveal an elevated specific gravity and ketone levels. In small children, serum chemistry testing may be performed to exclude hypoglycemia and metabolic acidosis (low serum bicarbonate levels and elevated anion gap).

Imaging Studies

  • No imaging studies are indicated.

Other Tests

  • Histopathologic examination of biopsy specimens does not reveal unique findings and is rarely indicated, except to exclude other diagnoses, such as pemphigus, cicatricial pemphigoid, carcinoma, and Behçet disease.
  • Persistent ulceration in an patient with human immunodeficiency virus (HIV) should be biopsied to exclude carcinoma.15

More on Aphthous Ulcers

Overview: Aphthous Ulcers
Differential Diagnoses & Workup: Aphthous Ulcers
Treatment & Medication: Aphthous Ulcers
Follow-up: Aphthous Ulcers
Multimedia: Aphthous Ulcers
References
Further Reading
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References

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Keywords

aphthous ulcers, aphthous stomatitis, canker sores, mouth sores, mouth ulcers, recurrent aphthous ulcers, RAU, recurrent aphthous stomatitis, RAS, aphthae minor, ulcerative stomatitis, Sutton disease, Sutton's disease, minor aphthous ulcers, major aphthous ulcers, herpetiform ulcers, Helicobacter pylori, malabsorption, celiac disease, regional enteropathy, myalgia, arthralgia, inflammatory bowel disease, gluten-sensitive enteropathy, Behçet disease, systemic lupus erythematosus, HIV, AIDS, Crohn disease, cyclic neutropenia, mouth and genital ulcers with inflamed cartilage, MAGIC syndrome, treatment, diagnosis

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Contributor Information and Disclosures

Author

Michael C Plewa, MD, Research Coordinator, Consulting Staff, Department of Emergency Medicine, Lucas County Emergency Physicians, Inc, and Saint Vincent Mercy Medical Center
Michael C Plewa, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Physicians for Social Responsibility, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Halim Hennes, MD, MS, Pediatric Emergency Medicine Research Director, Professor, Departments of Pediatrics and Emergency Medicine, Medical College of Wisconsin
Halim Hennes, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

Paul D Petry, DO, FACOP, FAAP, Consulting Staff, Freeman Pediatric Care, Freeman Health System
Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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