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  1. #1
    usmlemate is offline Junior Member
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    Aphthous Stomatitis

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    A 31-year-old HIV-infected man presents with painful sores in his mouth. His medications consist of tenofovir-DF (Viread), lamivudine (Epivir), and efavirenz (Sustiva); his CD4 count is 328 cells/mm3 and his HIV RNA is less than 50 copies/ml. The oral examination shows several moderately sized ulcerated lesions on the tongue and buccal mucosa (Figure 1). He has previously experienced several similar but less severe episodes. A fluorescent antibody and culture for herpes simplex virus are negative and the diagnosis of aphthous stomatitis is made.

    Which of the following is TRUE regarding aphthous stomatitis in HIV-infected patients?

    A. Cytomegalovirus infection has been identified as the cause of aphthous stomatitis.

    B. Thalidomide (Thalomid) is an effective therapy for aphthous stomatitis.

    C. The diagnosis of aphthous stomatitis is best made by performing a Gramís stain and observing multiple gram-positive rods lining the surface of mucosal cells.

    D. Oral valganciclovir (Valcyte) is an effective therapy for aphthous stomatitis, providing an approximate 85% clinical response rate.

  2. #2
    usmlemate is offline Junior Member
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    Re: Aphthous Stomatitis

    Quote Originally Posted by usmlemate
    A 31-year-old HIV-infected man presents with painful sores in his mouth. His medications consist of tenofovir-DF (Viread), lamivudine (Epivir), and efavirenz (Sustiva); his CD4 count is 328 cells/mm3 and his HIV RNA is less than 50 copies/ml. The oral examination shows several moderately sized ulcerated lesions on the tongue and buccal mucosa (Figure 1). He has previously experienced several similar but less severe episodes. A fluorescent antibody and culture for herpes simplex virus are negative and the diagnosis of aphthous stomatitis is made.

    Which of the following is TRUE regarding aphthous stomatitis in HIV-infected patients?

    A. Cytomegalovirus infection has been identified as the cause of aphthous stomatitis.

    B. Thalidomide (Thalomid) is an effective therapy for aphthous stomatitis.

    C. The diagnosis of aphthous stomatitis is best made by performing a Gramís stain and observing multiple gram-positive rods lining the surface of mucosal cells.

    D. Oral valganciclovir (Valcyte) is an effective therapy for aphthous stomatitis, providing an approximate 85% clinical response rate.
    The correct answer is B. Several studies have shown that thalidomide is effective for the treatment of oral and esophageal aphthous lesions in HIV-infected patients. Thalidomide is generally reserved for severe or corticosteroid-refractory cases. Because thalidomide has well-established teratogenic effects, strict safety precautions must be observed to ensure that it is safely dispensed to the appropriate patients.

    Answer A is incorrect. The cause of aphthous stomatitis remains unknown and there is no evidence that cytomegalovirus plays a major role, though cytomegalovirus infection can cause oral ulcers that resemble aphthous stomatitis. Investigators have proposed a number of factors that may contribute to this disorder, including overstimulation of tumor necrosis factor, immune cross-reactivity to infectious agents, nutritional deficiencies, stress, hormonal imbalance, food hypersensitivity, and genetic predisposition.

    Answer C is incorrect. The diagnosis of aphthous stomatitis is typically a diagnosis of exclusion. Herpes simplex virus infection should be ruled out, as was done with this patient. There is no evidence that Gramís stain provides useful information for diagnosing aphthous stomatitis.

    Answer D is incorrect. There is no evidence that oral valganciclovir is effective in treating aphthous stomatitis. Valganciclovir is used to treat cytomegalovirus infections and there is no evidence that cytomegalovirus causes aphthous stomatitis.

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