Abstract
Introduction
Bednar aphthae are infected wounds caused by trauma, localized to the hard palate in infants. They do not require specific treatment because they regress spontaneously in a few days. They often remain undiagnosed; other times, because of the pain they caused, they may worsen the nursing.
Case report
We describe the clinical case of a healthy infant of 2 months, fed with formula, who has 2 aphthous lesions in the oral cavity associated with irritability and inconsolable crying during feeding. We excluded the influence of infectious factors or underlying diseases. The hypothesis of a traumatic factor was supported by the anatomical features of aphthae and then confirmed by the gradual resolution of lesions after some advices on breastfeeding.
Conclusions
Our intent is to provide a photographic record of Bednar aphthae, which are quite common but often misdiagnosed also because of lacking of photographic material. Improved knowledge of this condition helps physicians in the differential diagnosis of a traumatic condition that is not as unusual as it seems in newborns.
1
Case report
In November 2010, a 2-month-old infant was admitted to the pediatric emergency department for frequent crying episodes, nursing difficulty, and irritability for the last month. He had no fever and was in general good conditions, and all vital signs were normal. At palate examination with tongue depressor, 2 big ulcers were observed. They were symmetrical, 2 × 1 cm in diameter, located between the hard and soft palate superiorly to the palatine tonsils. They presented with a hyperemic halo and were covered by yellow fibrin. All symptoms began immediately after tongue frenum removal in another hospital.
The infant stopped breastfeeding at 10 days of life and, since then, was bottle-fed.
All blood examinations were normal, with no evidence of ongoing inflammatory process. Viral antibodies were searched, and no evidence of viral infection was found. The only altered examinations were the antinuclear antibody test, extractable nuclear antigens test, antismooth muscle antibody, and antibody against Sjögren syndrome. All these tests showed a light positivity, and they were confirmed positive in his mother’s blood. This finding was consistent with a possible vertical transmission.
In hospital stay, low doses of acetaminophen and betamethasone were administered orally with a better control of crying and irritability symptoms. The mother was instructed to avoid feeding the infant while lying down. A smaller and orthodontic nipple for the feeding bottle was given to the mother. Eight days after, the palatine aphthae were the same in size, but the central fibrin layer had disappeared ( Fig. 1 ). Four months after, all symptoms had disappeared, and oral examination showed a complete resolution of mucosa lesions ( Fig. 2 ). Antinuclear antibody test after 4 months was decreased, as expected. Echocardiography was negative.
