2017 PEMPix Online Case #3: Little Circle

Cathryn Sabulski, MD
Riham Alwan, MD
Wendy Pomerantz, MD

Cincinnati Children’s Hospital Medical Center

Cathryn Sabulski, MD
Pediatric Resident
Cincinnati Children’s Hospital Medical Center


Four day old former full term female presenting with mouth lesions. Born at 40 week old via NSVD to a GBS negative mother. Mother denies any infections during pregnancy. No maternal history of HSV. Maternal grandmother has been helping with care and is currently on valcyclovir suppression for oral HSV. Taking two ounces of pumped breast milk every two to three without issue. Excellent urine output and normal stooling.

On the night prior to presentation, mother noted lesions on patient’s posterior oropharynx, so brought her in for evaluation. Otherwise no ill symptoms, no changes in behavior. No other lesions or rashes.

 

 


What are the pharyngeal lesions in this newborn?

A.   Neonatal herpes simplex virus

B.   Viral stomatitis (e.g., Coxsackie virus)

C.   Oral candidiasis

D.   Epstein pearls

E.   Bednar’s apthae

 


E.   Bednar’s aphthae

First described by Alois Bednar in 1850 characterized by painless white/yellow follicles or ulcers on an erythematous base localized to the anterior tonsillar pillars. They are usually seen on the second or third day of life and typically clear spontaneously within 2-4 days.

The exact etiology is unclear. Prior hypotheses have included lesions resulting from minor trauma (e.g., wiping out a neonate’s mouth), mechanical influences (e.g., non-orthodontic pacifier use), or secondary to immune process – however none of these have been substantiated.

HSV is less likely in this case because lesions are bilateral, occurred at <7 days of life and are localized to posterior palate only.

Management involves no specific treatment. Observe lesions until they resolve. However in this particular case it would be very hard to resist testing and treating for HSV and neonatal serious bacterial infections…

 

By | 2017-09-03T22:42:42+00:00 September 13th, 2017|Infectious Diseases, Otolaryngology, PEMPix|

About the Author:

Brad Sobolewski, MD, MEd is an Assistant Professor of Pediatric Emergency Medicine and an Assistant Director for the Pediatric Residency Training Program at Cincinnati Children’s Hospital Medical Center. He is on Twitter @PEMTweets and authors the Pediatric Emergency Medicine site PEMBlog. All views are strictly my own and not official medical advice.