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June 1991

Oral Ulcers and Cobblestone Plaques

Author Affiliations

Emory University, Atlanta, Ga, and the University of Michigan, Ann Arbor

Arch Dermatol. 1991;127(6):892. doi:10.1001/archderm.1991.01680050137019

REPORT OF A CASE  An 18-year-old man presented with a 3-month history of painful sores in his mouth, epigastric pain, and a weight loss of 11.25 kg (25 lb). Recent analysis of the patient's blood sample by his personal physician was said to show "problems with his liver." He denied any cutaneous lesions; specifically genital or perianal ulcers. He also denied penile discharge and occular inflammation. Findings from a physical examination showed multiple ulcerations on both the hard and soft palates and the buccal and gingival mucosae (Fig 1).Over the ensuing month, hematochezia developed. Examination of the patient's oral cavity revealed cobblestone plaques on the mucosal surface of his lower lip, in addition to the previously noted aphthous ulcers (Fig 2). A biopsy specimen of a cobblestone plaque showed granulomatous inflammation (Fig 3). A complete blood cell count revealed the hemoglobin to be 124 g/L (normal, 140 to

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