A 75-year-old woman with more than a 10-year history of hypertension and diabetes mellitus reported a 3-day history of throat discomfort and white eruptions on the tongue. On examination, multiple well-defined, white papules, 2 to 3 mm in diameter with a central punctum, were found on the surface of her tongue (Panel A). She reported only minimal oral pain. A shave biopsy revealed histologic findings typical of herpetic infection, including perinuclear halo, margination of chromatin, and multinucleated cells (Panel B, arrows). Culture of the lesions showed herpes simplex virus type 1 (HSV-1). Differing from herpetic vesicles on the skin, round, discrete areas of ulceration are the typical presentation of herpetic glossitis. Oral HSV-1 reactivation typically affects the keratinized surfaces of the mouth, whereas primary HSV-1 infection usually involves other mucosal surfaces as well. The typical clinical appearance of this condition differentiates it from oral candidiasis and aphthous ulcers. The lesions had healed completely, without any treatment, at the 2-week follow-up visit.
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