Multidisciplinary Exploration of Unknown Oral Lesions With Accompanying Oral Verrucas of the Tongue: A Case Report

TL;DR

An elderly man with unexplained oral lesions and fevers presented a complex diagnostic challenge requiring multidisciplinary care.

Contribution

This case report highlights the diagnostic complexity of unexplained fevers and oral lesions in elderly patients with comorbidities.

Findings

The patient exhibited persistent fevers, oral lesions, and gastrointestinal abnormalities without a clear etiology.

A multidisciplinary approach was required to manage symptoms despite negative CMV PCR and incomplete response to treatment.

The case emphasizes the need for collaboration across medical disciplines in managing complex clinical presentations.

Abstract

A 64-year-old African American male with a history of hypertension and type II diabetes mellitus presented with unexplained upper lip lacerations after several frequent episodes of hemoptysis. Following the upper lip lacerations were several weeks of intermittent unknown episodic fevers. The patient, challenged by impaired mobility, exhibited an array of symptoms, including severe upper lip pain with lacerations and white patches on the tongue. Laboratory findings indicated thrombocytopenia and anemia, with positive tests for both influenza A and B. Despite completing Tamiflu, the patient experienced recurrent fevers. Imaging revealed gastrointestinal abnormalities, leading to the initiation of nystatin and a multi-antibiotic regimen without significant fever resolution. A subsequent tongue biopsy revealed verruca lesions, and acyclovir was initiated. Despite this, the patient developed lip and facial blisters. Negative results from cytomegalovirus (CMV) deoxyribonucleic acid (DNA) polymerase chain reaction (PCR) prompted a shift in focus to managing persistent fevers, ultimately controlled with naproxen but without discoverable cause. This case underscores the diagnostic challenge posed by unexplained fevers in an elderly patient with oral manifestations. The protracted course and evolving symptoms emphasize the intricacies of managing such cases, highlighting the need for continued investigation and collaboration across medical disciplines in navigating complex clinical scenarios.

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