Photo Quiz: Scalded Mouth with Headache

摘要

The presence of multiple vesicles that vary in size and are confined to the right side of the hard palate (i.e., cranial nerve V2 distribution) accompanied by neuralgia and erythema in ipsilateral cutaneous portions of the right trigeminal nerve suggests herpes zoster over oral herpes simplex virus (HSV) infection. A positive Tzanck smear result showing multinucleated giant cells on a scraping from a vesicle base rules out other causes of oral lesions, but does not differentiate herpes zoster from HSV.1 A polymerase chain reaction (PCR) assay is the most sensitive test for identifying HSV and varicella zoster virus; it can detect viral DNA from vesicle fluid swabs, crusts, Tzanck smear debris, and tissue specimens fixed in formalin.