SCENARIO Oral Medicine

A male patient aged 45 years came with a complaint of burning sensation on his
oral tissue especially while eating salty/spicy food or drinking acidic beverages.
From clinical examintaion appeared red, flat, subtle lesions in the dorsal surface of
the tongue and on the soft palate with mild painful when they are touched. Some
molar teeth were fractures up to enamel thickness, but he did not feel any pain.
Progressive decayed teeth were also present. Single ulcerative lesion was detected
on gingival tissue of upper molar region. The ulcer was large, unusual looking or
fulminant ulcer. He said that ulcer has appeared since 4 days ago and were very
painful. Patient doesnt have any history of allergy, of hospitalization and of long
medication. However, in last one year patient more frequently had cold and
diarrhea that made him to consume OTC medications for these conditions. When
having cold, it was frequently accompanied with multiple small blisters on his lips,
sometimes also the blisters appeared on the palate and gums, then they were
rupture to produce small and painful ulcerative lesions that may coalesce. When
routine blood test was conducted it was detected that: WBC: 5,2 x 10 3/mm3, RBC:
4,8 x 103/mm3, HCT: 45%, HGB: 13,6 g/dL, Platelet: 130 x 103/mm3 , Lymphocyte:
10,1%, Neutrophil: 29,5%, Monocyte:5,2 %, Eosinophil: 2,1%, Basophil: 0,3%.
Personal History revealed that he is a bartender and he is still single. He routinely
goes to fitness center one in a week. He works everyday from 9 pm up to 3 am.