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Spontaneously Regressing Neonatal Oral Aphthous Ulceration Of The Palate

Madurapperuma, S. W. 2021Other/Unknown

Madurapperuma, S. W., Jayaweera, A. H. H. M., & Jayasinghe, R. D. (2021). Spontaneously Regressing Neonatal Oral Aphthous Ulceration of the Palate. Case reports in pediatrics, 2021, 6660302. https://doi.org/10.1155/2021/6660302

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Abstract

BACKGROUND: Neonatal oral aphthous ulceration of the palate also known as Bednar's aphthae is not an uncommon presentation. They clinically present as spontaneously regressing, shallow, and symmetrical ulcers on the posterior palate of newborns from 2 days up to 6 weeks of age. Case Presentation. We, herein, report a case of a one-month-old baby girl who presented with an ulcer in the posterior palate and intermittent mild fever. The patient was admitted and monitored in the ward. Haematologic investigations disclosed features of ongoing infection. Nasogastric feeding was commenced to avoid any irritation of the ulcer, and glycerine was applied on the ulcer. Antibiotic therapy was continued because of the intermittent mild fever. The lesion healed spontaneously within one week, and fever subsided afterwards. Currently, the patient is faring healthily without any complications. CONCLUSION: Although Bednar's aphthae is not a rare presentation, clinicians are often met with a diagnostic dilemma due to the alarming clinical presentation of this condition. Therefore, it leads to overinvestigation and overtreatment. With this case report, we would like to highlight the importance of being aware of this condition to provide the patients with the appropriate treatment.

Case Details

Disease Location

Mouth

Personal Characteristics

One-month-old baby girl

Clinical Characteristics

The mother had noticed a developing wound in the baby's mouth and complained that the baby had been having a fever on and off during the past two days. Upon examination, a unilateral symmetrical ulcer with a yellowish floor and an erythematous margin, measuring approximately 2 × 2 cm, was observed in the junction of the hard and soft palate. Intravenous cefotaxime treatment was commenced immediately. Haematological investigations revealed neutrophilic leucocytosis. Repeat inflammatory markers showed a marginal rise; antibiotics were changed to intravenous meropenem and metronidazole. Bednar’s aphthae caused due to traumatic feeding, was suspected. Nasogastric feeding was commenced. Glycerine was applied on the ulcer with a cotton swab.

Remission Characteristics

Despite the persistence of low-grade fever, the appearance of the ulcer improved drastically over a period of one week.

Treatment & Mechanisms

Proposed Remission Mechanisms

Generally, bednar’s aphthae regresses spontaneously without any complications

Clinical Treatment

Cefotaxime, meropenem, metronidazole, glycerine, nasogastric feeding.