Anemia the Culprit of Ora...

A 19-year-old male patient presented to our department reporting painful ulcers in the lower and upper lip as well as tongue regions persisting for the past 4 days. The patient reported a history of recurrent mouth ulcers occurring every 10–15 days for the past year, which typically resolve spontaneously. Additionally, the patient mentioned occasional constipation but is not currently using any medications for it. Upon examination, a small whitish-coloured ulcer measuring approximately 1 mm 1 mm with an erythematous boundary was observed on the right side of the lower labial mucosa opposite to 42 (Figure 1). Furthermore, two ulcers measuring approximately 3 mm 3 mm, covered with whitish necrotic material and surrounded by erythematous borders, were noted on the left side of the commissure area (Figure 2). Additionally, three tiny ulcers covered with whitish necrotic material and having erythematous boundaries were observed on the tip of the tongue. There are five ulcers, each approximately 2 mm * 2 mm in size, covered with whitish necrotic material and surrounded by an erythematous boundary located on the right side of the maxillary labial mucosa. Other observations include the presence of generalised mild supragingival calculus and mild extrinsic stains. A provisional diagnosis of recurrent aphthous ulcer was established. The patient was instructed to apply topical triamcinolone acetonide 0.1% and to take tablet prednisolone 5 mg orally. Additionally, the patient was advised to receive alternate-day intramuscular injections of vitcofol 10 ml for 10 days. A once-daily multivitamin regimen was also prescribed for the next 30 days. Upon examination after 10 days, the ulcers had completely healed without any scarring observed. The patient presented diagnostic test reports, including a CBC indicating an Hb level of 13.2 g/dl, a decreased RBC count of 3.88 x 10^6/mm3, an increased MCH level of 34.0 pg, and a deficiency in vitamin B12. Consequently, the patient was referred to both a physician and a gastroenterologist. The patient was advised to take laxatives for the treatment of constipation, along with tablet ferrous ascorbate 100 mg and tablet folic acid 1.5 mg with tablet vitamin C 500 mg once daily for a duration of 1 month. Additionally, the patient was prescribed tablet vitamin B12 1500 mcg.