Major recurrent aphthous ulceration: case report and review of the literature.

A 25-year-old male presented complaining of a large painful ulcer near the left tonsil persisting for two months. Biopsy, serologies and cultures were performed to rule out infectious etiology. Symptomatic treatment was prescribed and the ulcer spontaneously resolved. One year later he presented with a similar ulcer, this time near the right tonsil, persisting for three months. A diagnosis of Major Recurrent Aphthous Ulceration was made based on the history and on the exclusion of other diagnoses. Prednisone 60 mg was prescribed and the ulcer healed in one week, leaving a scar. The case illustrates an unusual presentation of aphthous disease because of the ulcer's size and duration. Major recurrent aphthous ulcers constitute 10% to 15% of recurrent aphthous ulcers. These lesions are greater than 10 mm in diameter, take 10 to 30 days to heal. Categorized as an idiopathic disease, they are painful and recur with varying frequency. It is estimated that 20% of the general population will suffer from recurrent aphthous ulcer. The major variety differs because it lasts longer, often leaves a scar, and more frequently needs systemic medication. In this case, the lesion demonstrated a good response to steroids.