In the case of a patient with multiple white lesions on the tongue and fever, what is the most likely diagnosis?

• A. Primary Herpetic Stomatitis
• B. Secondary Herpetic Stomatitis
• C. Herpangia
• D. Recurrent Apthous Stomatitis

Answer: (A)

The presence of multiple white lesions on the tongue, combined with fever, suggests an infectious process affecting the oral mucosa. Primary herpetic stomatitis, often caused by the herpes simplex virus type 1, is characterized by the sudden onset of numerous painful vesicles and ulcerations in the oral cavity. These vesicles can rapidly develop into whitish lesions due to necrosis and ulceration of the mucosa. Symptoms such as fever, malaise, and lymphadenopathy commonly accompany the lesions, particularly in primary infections.

In contrast, secondary herpetic stomatitis usually occurs in patients with a history of herpes simplex virus and would present differently, typically as localized lesions rather than widespread white lesions or systemic symptoms like fever. Herpangina is linked to enterovirus infections and primarily affects children, presenting with vesicular lesions in the posterior oropharynx rather than the tongue specifically. Recurrent aphthous stomatitis leads to painful ulcers but does not usually present with fever or widespread white lesions.

Thus, the combination of multiple white lesions and fever aligns closely with the clinical presentation of primary herpetic stomatitis, making this the most likely diagnosis in this scenario.