A patient presents with small grey vesicles and punched-out ulcers in the posterior pharynx. Which organism most likely causes this presentation?

A patient presents with small grey vesicles and punched-out ulcers in the posterior pharynx. Which organism most likely causes this presentation?

• A. Herpes Simplex Virus
• B. Coxsackie virus
• C. Adenovirus
• D. Enterovirus 71

Answer: (B)

This pattern is classic for herpangina, which is caused by Coxsackie A viruses. The telltale sign is fever with sore throat and small gray vesicles that rapidly ulcerate on the soft palate, uvula, and other areas of the posterior oropharynx, producing punched-out ulcers. The posterior location of the ulcers helps distinguish this from herpes simplex stomatitis, which more commonly involves the anterior mouth, lips, and gingiva with vesicles in those areas. Adenovirus can cause pharyngitis and exudates but doesn’t produce the characteristic posterior pharyngeal ulcers, and Enterovirus 71 can cause herpangina or hand-foot-mouth disease, but Coxsackie A remains the classic cause of this specific oral pattern.

This pattern is classic for herpangina, which is caused by Coxsackie A viruses. The telltale sign is fever with sore throat and small gray vesicles that rapidly ulcerate on the soft palate, uvula, and other areas of the posterior oropharynx, producing punched-out ulcers. The posterior location of the ulcers helps distinguish this from herpes simplex stomatitis, which more commonly involves the anterior mouth, lips, and gingiva with vesicles in those areas. Adenovirus can cause pharyngitis and exudates but doesn’t produce the characteristic posterior pharyngeal ulcers, and Enterovirus 71 can cause herpangina or hand-foot-mouth disease, but Coxsackie A remains the classic cause of this specific oral pattern.