Davina, a 25-year-old dancer, presents with a one-week history of expanding painful vegetative lesions on her ventral tongue and upper gingiva.

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Davina, a 25-year-old dancer, presents with a one-week history of expanding painful vegetative lesions on her ventral tongue and upper gingiva. She has also noticed some tiny yellow lesions on the tip of her tongue, with many also on her inner lips and cheeks.

She has used no new products and is apyrexial with an otherwise unremarkable physical examination. 

Davina was diagnosed with ulcerative colitis three years ago; her symptoms have remained in a quiescent state since being on oral mesalazine. She takes no other regular medications and has no known drug allergies.

Mucosal biopsies are sent for histopathological assessment. These identify microabscesses within the epidermis alongside multiple eosinophils.

Direct immunofluorescence is negative (antibody test). 

On blood tests, indirect immunofluorescence is negative, and a moderate eosinophilia is noted on her FBC. 

Swabs of the lesions culture only normal oral flora.