RT Journal
A1 Yepes JF, White D
T1 A young patient with persistent gingival bleeding
JF JAMA
JO JAMA
YR 2012
FD June 13
VO 307
IS 22
SP 2430
OP 2431
DO 10.1001/jama.2012.4307
UL http://dx.doi.org/10.1001/jama.2012.4307
AB 
A 13-year-old girl comes to your office for evaluation of ulcers, erythema, and a “peeling off” sensation in her gums. Her gums have been sore and red for at least 6 years. Initially she was diagnosed as having generalized gingivitis despite a low level of local irritants such as dental plaque or calculus. Her medical history is not significant and she is not taking any medication except cetirizine for seasonal allergies. Findings from a general physical examination are within normal limits. Her intraoral examination reveals ill-defined ulcers with marked erythema in the gums (Figure 1). The epithelium “peels” easily, leaving a thin membrane around the teeth. There is no evidence of significant dental plaque accumulation or the presence of local irritants such as calculus. Pertinent laboratory values (complete blood cell count, platelet count, liver panel) are within normal limits.