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Erythema Multiforme, Tongue Lesions, Purpura on Buccal Mucosa

Hi there,

I've been sick for six weeks. Doctors think I must have caught a strange virus. Tested for HIV, Mono, Hep A,B,C. All Negative. Liver and Kidney function within normal limits.

Six weeks ago my symptoms began with fever, night sweats, diarhhea, and strange lesions on the tip of my tongue. Basically my tongue looks like erythema multiforme, kinda like this, only without the scarring on the lip:
http://www.studydroid.com/imageCards/0b/87/card-11803657-front.jpg

Here's a photo of my actual tongue, 3 weeks later:
http://www.medhelp.org/photos/show/7769562?type=posts

Night sweats went away but the tongue illness remains and rises and falls in terms of severity. but numbness on the tip of my tongue, swollen (grooved) tongue edges, and enlarged red papuliae on the tip of the tongue are a constant. Lately, in the last 3 weeks, I also began getting blood blisters/purpura on the inside of my cheeks, i.e., on my buccal mucosa, and occasionally on my upper and lower lip.

My complete blood count was thrown off, but seems to be improving. Right now everything is within normal range except my lymphocytes (my lymphocytes are currently @ 1.3 ... normal is 1.5-4.0). My lymphocytes have been low for several weeks consistently. I'm wondering if anyone has had similar symptoms or can offer any insights.

Thanks!

38 Responses
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Avatar universal
Even I do not think of ITP with normal count.But a vasculitis, yes. Could I have your drug history? I do not think of a lympoma here.ok?
Helpful - 1
Avatar universal
A localized reactive purpura to an external allergen though extremely rare has been recorded.
My good wishes.
Helpful - 0
Avatar universal
Hey everyone. I just signing in to say that I've seen a HUGE improvement in my oral symptoms (geographic tongue and purpura) ever since quitting soy. I was drinking a lot of soy milk, pretty much 1/2 a litre per day on average. I now suspect that I developed a soy allergy or that the soy interfered with my zinc absorption. If you're getting geographic tongue, I strongly recommend you look at your diet very carefully. Good luck to everyone
Helpful - 0
Avatar universal
Arthralgias which you have/had do not fit in with the reactive arthritis, one of the hallmarks of Reiter's which is associated conjuctivitis, balanitis and keratoderma.
Best wishes.
Helpful - 0
Avatar universal
Correction, "dilation of the aortic root and ascending aorta", which is seen in reiter's syndrome (reactive arthritis), was also detected in my echocardiogram
Helpful - 0
Avatar universal
Hi Maatson, I wonder what you think of reactive arthritis (reiter's syndrome) in my case. I had a negative ANA and my ESR was 0. Still, chest pains due to aortic dilation, oral lesions including geographic tongue and papules, amyloid deposits, are all possible symptoms of reactive arthritis. I had severe myalgia but only for a couple of days during the first weeks of illness. Recently I've noticed some odd unexplained joint pain but it is very localized in the right hand. Let me know if you know of any tests that might help rule out Reiter's as a cause.

Thanks again
Helpful - 0
Avatar universal
Angina bullosa haemorragica (Traumatic oral Haemophyctenosis) is the condition that is what you mention.
Good!
Helpful - 0
Avatar universal
I was wondering if you know whether oral inflammation can cause post-inflammation oral purpura. During the early acute phase of this illness, I had a swollen tongue, which was often scalloped by teeth indentations around the edges. I also had a white bumpy ridge, more pronounced or inflammed than usual, running from the corner of my lips, along the interior of the buccal mucosa, to where the the molars meet. It was after this inflammation mostly subsided that the purpura first appeared. At present, any minor trauma, such as the accidental biting of my tongue or buccal mucosa, produces a localized dark red blister/purpura at the site of oral trauma.

Also I thought I'd mention the good news that I didn't have any night sweats last night.

Helpful - 0
Avatar universal
Only about one third show ANA positivity in pemphigus, and also Beau's lines are casual associations.A generalized condition and rather uncommon in your age group is pemphigus. Benign mucosal pemphigoid is more localized but again the age group.
Best wishes.
Helpful - 0
Avatar universal
Hi Maatson, you've been great so far at suggesting possible causes. I'm working on a list of possible causes to present to my internist. I was wondering what you think of pemphigus. It can have some strange effects on the oral cavity, including symptoms that mimic geographic tongue, as seen here from this photo found on the internet:

http://www.medindia.net/patients/patientinfo/images/Pemphigus-3.jpg

Pemphigus is also closely associated with beau's lines. I did indeed have beau's lines on my thumb and several fingers:

http://www.medhelp.org/user_photos/show/269963

However, I believe Pemphigus is an auto-immune condition and so it should present with a positive ANA? My ANA test result was < 1:40 (negative). But I have been re-tested for ANA and should know the results by the end of this week.

Any thoughts about my beau's lines (which I forgot to mention up until now) and my ideas about pemphigus? Thanks again Maatson. I owe you one.

Helpful - 0
Avatar universal
Remember back about my referring to a possible adenovirus causing EM.  It is believed that valtrex is effective in this condition.
Regards.
Helpful - 0
Avatar universal
Thanks again.

What do you make of the fact that valtrex seems to have had such a positive effect on my symptoms during week two.  See the symptoms & medications chart in my profile photos section please. Three or four days after starting valtrex my symptoms all subsided except some geographic tongue. Three or four days after stopping valtrex my symptoms all came back and lasted for another week before the night sweats disappeared. I have read that valtrex is only effective and prescribed for herpes family viruses like hsv 1&2, cmv and ebv. I've also asked an expert at The Body.com about valtrex and HIV and they told me that valtrex would be unlikely to have any effect on primary HIV are symptoms or on the time taken by the host to produce antibodies.

Please let me know your thoughts about my experience with valtrex  

I also took nystatin while taking Valtrex but I think that the nystatin had little to no effect.
Helpful - 0
Avatar universal
Extremely unlikely- with your results mentioned.ok?
Helpful - 0
Avatar universal
Hi Maatson

Would you agree with others that HIV is an unlikely cause? I had four incidents of unprotected vaginal sex in three months preceding the onset of symptoms. 4th generation combo tests at 4 12 18 28 and 42 days post symptom onset were all negative.

I will have my doctors look into TB And the test you mentioned
Helpful - 0
Avatar universal
Do get a mantoux test to rule out a tubercular aetiology with special reference to night sweats.
With not much leads this seems another option here.
Hope we have a name to your condition and initiate therapy.
My good wishes.
Helpful - 0
Avatar universal
Hi again. Just thought I would add that after 6 weeks of peace at night my night sweats have returned. They started again two nights ago seem to be getting worse. Tonight I'm back to having to change my shirt  
Helpful - 0
Avatar universal
Do not worry and things will turn out to be localized.Regards.
Helpful - 0
Avatar universal
Hi Maatson

According to the internal medicine specialist the murmur is not very pronounced and may have been pre existing. I have an echocardiogram scheduled for this coming Monday. I also had a lot of new blood tests ordered by the internist so I shoul have those results by the end of next week. I'll let you know what I find out!  Thanks for your help and ongoing attention!
Helpful - 0
Avatar universal
Fever and petechie and cardic murmer. Do they think of sub acute Bacterial endocarditis? But then you do not have preexisting valve defect.
Let us see.
Helpful - 0
Avatar universal
Sure. Do keep me informed.ok?
Helpful - 0
Avatar universal
Hi Maatson. My dermatologist referred me to an infectious disease specialist today. He said my symptoms were serious and required urgent attention. He was alarmed when he noted a heart murmur while listening to my heart. He said the murmur could be the result of an underlying infection. He also gave serious consideration to the idea that an exposure to an exotic fungus or bacteria in my apartment may have caused the illness. I'll let you know what the infectious disease specialist says. Thanks again for your help
Helpful - 0
Avatar universal
This is typically a mucous cyst of minor salivary glands and is ok. Do keep me informed.
Best wishes.
Helpful - 0
Avatar universal
Hi Maatson, I hope you're doing well. I'm waiting to see a dermatologist and still getting geographic tongue and those odd purpura on the buccal mucosa. Yesterday I also noticed a water filled cyst underneath my tongue. It has since burst and is not painful. I thought I'd post a picture in case it provides any clues about my illness:

http://www.medhelp.org/user_photos/show/269094

Please let me know if it gives you any new ideas about what might be effecting me. Thanks again!
Helpful - 0
Avatar universal
Thanks again Maatson. I'll post any new information or test results I have following my specialist appointments. Please check back when I do to offer your opinion!

Be well & Take care!
Helpful - 0
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