Zola and zahwa were presented with mouth ulcer. Zola (7 y.

o boy) had soreness at the angles of the mouth for 2 weeks and discomfort caused by opening the mouth. Zola also noticed of tootache of his second right molar since a week ago and worsen upon eating while zahwa (18 y.o,zola oldest sister) felt recurrent soreness on the lips, tounge and bucall mocusae since 5 days ago. As per history taking with zahwa the soreness were worsened upon eating,drinking and odynodisfagiawas noted without disfagia thus she loss here apetite most of the time. Both had neither sign of flu like symptoms not fever. Both are otherwise healthy and report no genital and anal ulcer,skin rash,recurrent diarrhea,nausea,vomiting,abdominal bloating,joint paint or swelling. It seemed the mother and grandmother had the same illness with zahwa during childhood an adolescence. Both showed no history of minor trauma ,allergies,and weight loss. No medication are used recently. Zola doesnt brush his teeth regulary and like to eat and drink sweet food and beverage, he like chocolate a lot. On the contary zahwa oral hygiene is good instead of her found of spicy food and crackers. Zahwa will soon joint university test and shes afraid that she cant get the public university.

On physical examination vital sign of both patient were within normal limit. The pathological condition confined to the mouth,oropharinx,and dental. There were no sign of anemia, no injection of conjunctiva and no cervical lymphadenopaty. Heart and lung were all clear. The abdomen was flat with normal bowel sound. Its thympanic ,soft and non tender. Liver and spleen were no felt. No CVA tenderness. There was no rash,ptechie,purpura,no sign of joint inflammation. Genital showed no secret and ulcer. Zola mouth the angular of the mouth appears red and fissured with the periphery of the lesion less erytematosus than central areas with crusting,without lips swealing. Mucosa labial,buccal,lingual and oropharynx: intact in shiny pink color,no ulcer,no hemathome,no sign of inflamationon ginggiva leukoplakia(-). Teeth 7 6 5 4 3 2 1 7654321 1234567 1234567

The second left lower molars showed occlusal fissure, no plaque.

Vitality test : (+) Percussion test and oclusal,buccal and lingual : (+) A full blood count had been carried out and the result as of the follow. Hb 12,9 gr/dL ; RBC 4,7x106/uL ; WBC 9800 cells/mm3,Hct 37,5% Difcount : 3 , 2 , 67 , 22 ,3. Swabs and smears were take revealed candida albicans sp and staphillococus aureus. Zahwa mouth several ulcers and labial,buccal,ventral of lingual,the floor of the mouth and oropharynx , 3-5 mm diameters, round/ovoid with white-yellow base and have eritematosus halos. Vesicle(-) no sign of inflammation on gingiva, leukoplakia (-) Diagnosis : Zola : Angular cheilitis and caries dentis profunda of the second left lower molar with pulpitis. Zahwa : Minor recurrent aptosus stpmatitis