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February 12, 1982

Ulcer of the Hard Palate

JAMA. 1982;247(6):819-820. doi:10.1001/jama.1982.03320310067037

ULCERATION of the hard palate may be caused by neoplasm, trauma, systemic lupus erythematosus, Wegener's granulomatosis, midline granuloma, syphilis, and fungal, protozoal, and mycobacterial infections.1

Report of a Case  A 28-year-old man experienced pharyngitis, fever, and a 9-kg weight loss over a two-month period. During a two-week interval, the patient was treated with various antibiotics for a presumed bacterial pharyngitis, but his condition did not improve. An otolaryngologist found the patient to have an oronasal fistula, and results of a biopsy specimen of this lesion showed "acute necrotizing granulomatous inflammation compatible with Wegener's granulomatosis or midline granuloma." The patient continued to have fever, lose weight, and complain of a nonproductive cough, but denied any previous exposure to tuberculosis or the ingestion of unpasteurized milk.At time of his admission to Charity Hospital, New Orleans, his blood pressure was 120/70 mm Hg; pulse rate, 110 beats per minute; temperature, 39.4