This document discusses various medical conditions that cause rashes or lesions in the mouth (enanthems). It provides 10 cases describing the presentation of oral rashes caused by conditions such as candidiasis, herpangina, hand-foot-and-mouth disease, herpetic gingivostomatitis, eruptive gingivitis, necrotizing gingivostomatitis, aphthous ulcers, Behcet's syndrome, and geographic tongue. It also mentions dental cysts. The document compares the clinical features of these various conditions to determine the most likely diagnosis for each case.

1. Enanthem
Enanthem are medical terms for a rash (small
spots) on the mucous membranes.
Causes:1-local diseases.
2-systemic diseases
3-It can also indicate hypersensitivity

2. A 7-day-old infant develops white,
cheesy patches on the tongue and buccal
mucosa with mild inflammation of the
mucosa. Which of the following organisms
is most likely the cause of these oral
lesions?
(A) Candida albicans
(B) Listeria monocytogenes
(C) Escherichia coli
(D) group A streptococcus
(E) group B streptococcus
(1)

3. (A) The findings described are typical of thrush
(oral infection with C albicans), which is common in
young infants. Although E coli, L monocytogenes,
and group B streptococcus all are important
pathogens in the neonatal period, they typically
are not associated with pharyngeal infection or
oral exudate.
Group A streptococcus is a common cause of
exudative tonsillitis in the older child but is an
extremely rare pathogen in the newborn infant
likely due to maternally acquired antibody.
Additionally, the exudate noted with group A
streptococcal infection would be in the area of the
tonsils rather than on the buccal mucosa.
(Behrman, 870, 1392; Brodsky, 204)

4. Causes;
1-prolonged antibiotic ttt.
2-malnutrition.
3-T.cell immundef.
4- neonatal .

5. An 18-month-old child presents to your office
with a 2-day history of fever. He is not eating
well and the mother tells you that she thinks
his mouth hurts. On examination you see 3 mm
vesicles on erythematous bases on the soft
palate and tonsils. What is the most likely etiology
of this infection?
(A) streptococcal pharyngitis
(B) herpangina
(C) herpes simplex virus
(D) human herpes virus 6
(E) candida pharyngitis
(2)

6. Herpangina
-coxsackievirus.
-<5yrs.
-fever +refusal of feeding.
-size< 5mm.
-number <5.
-subsided in 5days.

7. (B) Herpangina is a syndrome characterized
by small vesicles or punched-out ulcers on the tonsils and
fauces, uvula, pharynx, and edge of soft palate. The remainder
of the mouth and throat usually appear normal on examination.
Infections caused by group Astreptococcus and candida do not
present with vesicular lesions. Thevesicular lesions seen in
HSV infection are generally limited to the anterior portion of
the mouth in immunocompetent individuals. HHV-6 is the
causative agent of roseola, which does not generally cause an
enanthem. (Long, 201, 1151

8. The child in the above question also has small
vesicular lesions on his palms and soles. You
suspect hand, foot, and mouth syndrome.
What virus is the most likely causative agent of
this disease?
(A) adenovirus
(B) group A streptococcus
(C) Arcanobacterium haemolyticum
(D) coxsackievirus A16
(E) herpes simplex virus
(3)

9. (D) Hand-foot-and-mouth syndrome is a specificsyndrome that can be caused
by a variety of viral agents. It was originally described in association
with coxsackievirus A16, but enterovirus 71 can cause an identical clinical
picture. Group A streptococcus and Arcanobacterium haemolyticum cause
similar manifestations of exudative pharyngitis. However the latter is a much
less common cause of pharyngitis. Adenovirus does not typically cause
enanthem. While HSV infection can cause oral as well as digital lesions, this is
an atypical presentation with occurrence on both the palms and soles.
(American Academy of Pediatrics, 284; Long, 1152)

11. (4)
Herpetic gingivostomatitis

12. Acute infection of oral cavity caused by herpes simplex virus.
Herpetic gingivostomatitis is the most common
cause of stomatitis in children aged 1–3 years.
There is often a high fever, fetor oris, refusal to
eat, and irritability. The lesions are initially
vesicular, and soon form ulcers ranging from 2 to
10 mm in diameter. The tongue, cheek, and gums
are usually involved, and there may be
submaxillary Lymphadenitis
--Herpes simplex .
--Fever+salivation+refusal of feeding.
--Most common cause of stomatitis.
--Last for 4-8 days.

13. (5)
Eruptive gingivitis

14. --Difficult teething.
--Bacterial invasion may
responsible for fever+ irritability.
Eruptive gingivitis

15. (6)
acute necrotizing gingivostomatitis

16. A condition characterised by progressive necrosis of
intraoral tissues and upper respiratory abscesses, which
is seen in those with poor oral hygiene and suboptimal
nutrition, often linked to herpes simplex and anaerobic
flora—e.g., Fusobacterium spp, spirochetes.
Fever+ pseudomembrane over affected gingiva
-fetor oris +cx LN +may extend to facecancrum oris
Ttt-Antibiotic+local antiseotic+analgisic

17. (7)
are painful ulcerations, which present as
erythematous, indurated papules that erode to form
circumscribed necrotic ulcers with gray fibrinous
exudates and erythematous halo. They are 2–10 mm
in diameter, heal spontaneously,often recure
Aphthous ulcerations
(canker sores)

18. (8)
Behçet syndrome

19. Behçet syndrome
is a multisystem disorder
characterized by recurrent oral and
genital ulceration, iritis or uveitis, as
well as other
cutaneous, arthritic,neurologic,
vascular,and gastrointestinal (GI)
manifestations.
It is rare in children

20. geographic tongue (9)

21. geographic tongue
--Benign condition.
--Misdiagnosed.
--Need no ttt.
--Red patches with whitish margin.
--Asymptomatic.
--Persist for several weak and may
recur.

23. (10)
Dental cyst

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