Discussions By Condition: I cannot get a diagnosis.

Seasonal fatigue & mouth sores in teenager

Posted In: I cannot get a diagnosis. 9 Replies
  • Posted By: SoccerCheerMom
  • February 7, 2009
  • 09:20 PM

Hi there, my 15 year old daughter experiences extreme fatigue and mouth sores every February through April. Ulcers appear under her tounge and she has rash-like appearance and peeling on the inside of her cheeks. Both the ulcers and "rash" are very painful. She has had the ulcers and rash biopsied with normal results. The fatigue is so extreme that she has trouble fuctioning. She has been put on anti-depressants (Prozac last year, Lexapro this year) with no effect on the fatigue or ulcers. We are both very confused about what's going on and the only suggestion we have been given from the doctors (primary doctor, dentist, ENT, oral surgeon, pathologist) is that it could be a virus, which we thought was rediculous until it cleared up. I assumed they must have been right about the virus until the symptoms returned at exactly the same time of year. Does anyone have any ideas of what could causing this?

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9 Replies:

  • Hi there, my 15 year old daughter experiences extreme fatigue and mouth sores every February through April. Ulcers appear under her tounge and she has rash-like appearance and peeling on the inside of her cheeks. Both the ulcers and "rash" are very painful. She has had the ulcers and rash biopsied with normal results. The fatigue is so extreme that she has trouble fuctioning. She has been put on anti-depressants (Prozac last year, Lexapro this year) with no effect on the fatigue or ulcers. We are both very confused about what's going on and the only suggestion we have been given from the doctors (primary doctor, dentist, ENT, oral surgeon, pathologist) is that it could be a virus, which we thought was rediculous until it cleared up. I assumed they must have been right about the virus until the symptoms returned at exactly the same time of year. Does anyone have any ideas of what could causing this? Where do you live? If you live in the North part of the world, then I would suspect vitamin D deficiency to be contributing to your daughter's troubles. This is very underdiagnosed and becoming increasingly common. A simple blood test will rule this out, and should have been done since her symptoms appear in the winter months (lack of sun= lack of D). Vitamin D deficiency can cause periodontal and gum problems, as well as SAD (seasonal affective disorder) as well as whole body pain and extreme fatigue. I would just rule this out. Best wishesDOM
    acuann 3,080 Replies
    • February 7, 2009
    • 10:41 PM
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  • Thank you very much! I will ask her doctor if that was checked in the bloodwork. I think I'll start her on some Vitamin D supplements as well. I appreciate the advice!!P.S. We live in north eastern West Virginia
    SoccerCheerMom 3 Replies
    • February 7, 2009
    • 10:58 PM
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  • Thank you very much! I will ask her doctor if that was checked in the bloodwork. I think I'll start her on some Vitamin D supplements as well. I appreciate the advice!! P.S. We live in north eastern West Virginia If you want a definitive diagnosis on the D, then I would hold off on supplementing until you get the levels checked. Otherwise this will skew the results. Very low levels (10 and under) may require megadoses of D...so if you can get the test done first it would be best. That way you'll know better how much she'll need to supplement. Hope this makes sense. Best wishesDOM
    acuann 3,080 Replies
    • February 8, 2009
    • 02:57 AM
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  • Good point, I didn't think about that. I will hold off on the supplements! Thanks again!!
    SoccerCheerMom 3 Replies
    • February 8, 2009
    • 03:20 AM
    • 0
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  • Is there a pollen that's there just from Feb. to April?
    richard wayne2b 1,232 Replies
    • February 8, 2009
    • 01:34 PM
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  • How many years has this been going on?
    richard wayne2b 1,232 Replies
    • February 8, 2009
    • 01:35 PM
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  • Richard, This is the second year. I was thinking the same thing about maybe an allergen so we tried Claritin and Zyrtec last year with no luck.Blaze, she does use a cell phone...constantly! :o) The article was very interesting.Thank you both for responding!
    SoccerCheerMom 3 Replies
    • February 8, 2009
    • 06:46 PM
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  • The mouth ulcers, known as apthous ulcers, and rash are attributed to Stomatitis and this type of response can be infrequently associated with a histimine 1 similar to that observed in persons with seasonal rhinitis, or alternatively histamine II which involves the GI tract. The precise cause, however, remains unknown at present. As for the mucosal membranes of the cheeks, this is due to Epitheliolysis and I would wonder whether at the point the stomatitis appears, your daughter begins using any type of special toothpaste or mouthwash, both of which can induce lysis of the outer mucosal membrane. While the recurrent apthous stomatitis (RAS) is certainly painful, epitheliolysis typically is not. Having said that, it may be difficult for her to tell once the stomatitis is present. Furthermore, by the description, this is likely RAS type B or possibly C, which are treated with clorhexadine mouthrinse (alcohol free variant) and a course of corticosteriods when either the prodrome is detected, if it exists, or when the ulcers first begin to appear. It's very important here that a viral cause for the ulcers be ruled out prior to treatment with corticosteroids. Secondly, treatment with steroids should always begin with topical forms first to determine whether benefit is being obtained. Also, if in response to the appearance of the ulcers, she is using certain mouthwash or toothpaste in the attempt to forestall the onset, these products are very likely the cause for the epitheliolysis or peeling of the skin on her cheeks and should be avoided. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • February 9, 2009
    • 00:35 AM
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  • Could this be an allergic reaction to some seasonal food that shows up this time of the year? Tomatoes? Fatigue can be a part of an allergic reaction. Good luck in finding the cause to this mystery! :)
    Felsen 510 Replies
    • February 9, 2009
    • 01:56 AM
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