Question 1

Q: A 27-year-old dental radiographer presented to a clinic with red lesions on his palate, right lower and mid-upper lip, as well as one of his fingers. These lesions were accompanied by slight pain, and the patient had a low-grade fever 1 week before the appearance of the lesions. The patient touched the affected area repeatedly, which resulted in bleeding. Two days prior to his visit, he observed a small vesicular eruption on his right index finger, which merged with other eruptions and became cloudy on the day of the visit. He has not had similar symptoms previously. He did not report drug usage. A Tzanck smear was prepared from scrapings of the aforementioned lesions by the attending physician, and multinucleated epithelial giant cells were observed microscopically. According to the clinical presentation and histologic finding, which viral infection should be suspected in this case?

Herpes simplex infection. ***Herpes simplex infection*** - The presence of **red lesions on the palate, lips, and finger**, along with **vesicular eruptions** that become cloudy and are accompanied by **pain** and a preceding **low-grade fever**, are classic signs of **herpes simplex virus (HSV) infection**. - The histological finding of **multinucleated epithelial giant cells** on a **Tzanck smear** is highly characteristic of herpes virus infections, including HSV. *Varicella-zoster infection* - While **varicella-zoster virus (VZV)** also causes vesicular lesions and produces multinucleated giant cells, it typically presents with a **widespread rash** (chickenpox) or a **dermatomal distribution** (shingles), which is not described here. - The patient's initial symptoms are more consistent with **primary herpes simplex infection**, particularly with the localized presentation. *Measles* - **Measles** presents with a characteristic **maculopapular rash** that starts on the face and spreads downwards, often preceded by **Koplik spots** in the mouth, and significant **catarrhal symptoms** (cough, coryza, conjunctivitis). - It does not typically involve vesicular lesions or the presence of multinucleated giant cells on a Tzanck smear. *Herpangina* - **Herpangina** is characterized by painful **vesicles and ulcers localized to the posterior oropharynx** (soft palate, tonsillar pillars, uvula), typically caused by Coxsackieviruses. - It does not usually affect the lips or fingers, and a Tzanck smear would not show multinucleated giant cells. *Hand-foot-and-mouth disease* - **Hand-foot-and-mouth disease (HFMD)** is caused by coxsackieviruses and presents with **vesicular lesions** on the **hands, feet, and oral cavity**, particularly the tongue and buccal mucosa. - While oral lesions are present, the specific involvement of the palate and the characteristic Tzanck smear findings point away from HFMD.

Question

A 27-year-old dental radiographer presented to a clinic with red lesions on his palate, right lower and mid-upper lip, as well as one of his fingers. These lesions were accompanied by slight pain, and the patient had a low-grade fever 1 week before the appearance of the lesions. The patient touched the affected area repeatedly, which resulted in bleeding. Two days prior to his visit, he observed a small vesicular eruption on his right index finger, which merged with other eruptions and became cloudy on the day of the visit. He has not had similar symptoms previously. He did not report drug usage. A Tzanck smear was prepared from scrapings of the aforementioned lesions by the attending physician, and multinucleated epithelial giant cells were observed microscopically. According to the clinical presentation and histologic finding, which viral infection should be suspected in this case?

Accepted Answer

Herpes simplex infection

Answer

Varicella-zoster infection

Answer

Measles

Answer

Herpangina

Answer

Hand-foot-and-mouth disease

Viruses — MCQs

Viruses — MCQs

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