Recurrent aphthous ulceration: a possible clinical manifestation of reactivation of varicella zoster or cytomegalovirus infection.

The etiology of the most common intraoral mucosal disease, recurrent aphthous ulceration (RAU), remains obscure. Here, attempts were made to diagnose reactivation of varicella zoster (VZV), cytomegalovirus (CMV), Epstein-Barr (EBV) and human hepes virus 6 (HHV-6) infections from paired sera in association with RAU recurrences. The first sample was obtained within 3 days after a new recurrence (1) and the second 10-14 days later (2). The study initially comprised 18 otherwise healthy RAU patients (gr A) and 17 sex- and age-matched healthy non-RAU individuals. Values of specific antibody subclasses (IgM, IgG, IgA) were determined by ELISA (VZV, CMV, EBV) and IFA (HHV-6). Patients and controls exhibited differences in parameters on specific VZV IgM and CMV IgM. In order to substantiate these findings, specific VZV IgM and CMV IgM were subsequently also evaluated in 17 other RAU patients (gr B). Ten patients in gr A and 11 in gr B were IgM seropositive for either VZV and/or CMV in at least one of the serum samples, whereas in the controls only one was VZV IgM positive and none CMV IgM positive. Evaluated as groups, optometric density (OD) antibody levels of VZV IgM were significantly higher in the patients (gr A (1,2) vs controls: p < 0.0001; gr B (1,2) vs controls: p < 0.001). CMV OD IgM antibody values were significantly higher in gr B only (1,2 vs controls: p < 0.01). The study lends support for reactivation of VZV and/or CMV infection associated with RAU recurrences.