A man in his 60s with no significant medical history presented to the dermatology clinic for evaluation of a gray-white plaque on his soft palate. These findings developed over the prior week and did not improve after treatment with 3 days of oral cefuroxime. The patient reported no sore throat, dysphagia, hoarse voice, cough, dyspnea, nausea, vomiting, headache, fever, night sweats, weight loss, rash, or genital, rectal, or oral ulcers over the past 6 months. He was taking no regular daily medications, did not smoke cigarettes, and had no history of oral trauma. Over the prior 6 months, he reported sexual contact with 1 male partner. Physical examination revealed irregular gray-white ulcers with a surrounding erythema on the soft palate, uvula, and tonsils (Figure 1) and nontender bilateral submandibular lymphadenopathy. His tongue was of normal appearance, and he had no skin lesions or mucosal erosions in the anal or genital areas.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Jianjun Qiao, MD, PhD, Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Rd, Hangzhou 310003, China (email@example.com).
Published Online: February 2, 2023. doi:10.1001/jama.2023.0150
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for providing permission to share his information.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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