Tzanck smears from the buccal mucosal ulcer and the tongue vesicle demonstratednumerous multinucleated giant cells and ballooning degeneration of the epithelialcell nuclei. The multinucleated giant cells showed molding of the nuclei andperipheral chromatin clumping characteristic of herpesvirus infection. Theviral culture was positive for HSV type 1. Oral famciclovir therapy was started,and the patient rapidly improved within 7 days of treatment.
Oral HSV infections are common. The clinical presentation of a primaryinfection includes painful and/or pruritic papules and/or vesicles near thesite of inoculation, and may include the association of fever, myalgias, andother influenzalike symptoms. Recurrent HSV often presents with pain, burning,or pruritis, followed by the development of grouped vesicles on an erythematousbase. Typically, oral HSV infections include both mucosal and vermilion involvementor vermilion involvement alone.
A 64-Year-Old Man With Glossitis. Arch Dermatol. 2001;137(1):85-90. doi: