Erythema Multiforme, Tongue Lesions, Purpura on Buccal Mucosa

[neveragain22]

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!

[maatson]

Angina bullosa haemorragica (Traumatic oral Haemophyctenosis) is the condition that is what you mention.
Good!

[neveragain22]

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.

[maatson]

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.

[neveragain22]

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.

[maatson]

Remember back about my referring to a possible adenovirus causing EM.  It is believed that valtrex is effective in this condition.
Regards.

[neveragain22]

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.