Striking Oral Manifestation of Primary Herpetic Gingivostomatitis: A Case Report and Review of Human Herpesvirus Infections.

Background: Human Herpesvirus (HHV) is a double-stranded DNA virus with a size of 120 to 260 nm. HHV is divided into three subclassifications including herpesvirus alpha, herpesvirus beta, herpesvirus gamma. The HHV group could infect the human body including the orofacial area with mild to severe symptoms. This case report will discuss the diagnostic approach by recognizing the characteristics of each HHV group infection.

Case presentation: A 23-year-old male patient with complaints of mouth ulcers since 7 day, accompanied by pain when swallowing which was preceded by a fever. Extraoral examination showed vesicles, measuring 5 mm, multiple on the upper and lower lips. Intraoral examination showed multiple ulcers, measuring 5 mm on the left buccal mucosa, tongue, and gingiva accompanied by enlargement of the anterior gingiva and palatine rugae. The diagnosis was Primary Herpetic Gingivostomatitis, with herpangina considered as a differential diagnosis.

Case management: Treatment included acyclovir tablets, nystatin suspension, multivitamins, petroleum jelly, and oral hygiene and dietary instructions. There was improvement in the vesicles on the lips and ulcers on the buccal mucosa, tongue, and gingiva within one week, though white plaque remained on the dorsum of the tongue.

Conclusion: Characteristics of oral manifestations caused by HHV infection include symptoms of fever, vesicles, multiple ulcers measuring less than 1 cm, and gingival enlargement as the basis for establishing a diagnosis of Primary Herpetic Gingivostomatitis related to herpesvirus alpha infection, although ulcers also appear in herpesvirus beta and herpesvirus gamma but usually the ulcers will persist for more than two weeks with a relatively larger size, not accompanied by vesicles, and no gingival enlargement.