Raw erythematous areas with bleeding spots on a boy with juvenile diabetes mellitus

 # A 9 year old boy visited OPD for soreness in the mouth. He had history of juvenile diabetes mellitus and was on insulin therapy. On intraoral examination, a large white scrapable lesion was noted on the soft palate. Raw erythematous areas with bleeding spots were seen after scraping the lesion. What is the most likely diagnosis to be?

A. Diphtheria

B. Oral Thrush

C. White Spongy Nevus

D. Vincent’s stomatitis

E. Chronic Hyperplastic Candidiasis

The correct answer is B. Oral Thrush

Oral thrush (pseudomembranous candidiasis) is the most likely diagnosis, characterized by white, creamy plaques on mucosal surfaces like the soft palate that scrape off easily, revealing underlying erythematous, raw tissue prone to bleeding—directly matching the presentation. Juvenile diabetes mellitus predisposes to this via hyperglycemia impairing immune response and promoting Candida albicans overgrowth, common in children on insulin. Diagnosis is clinical, confirmed by microscopy if needed (hyphae in KOH prep). Treatment involves topical antifungals (e.g., nystatin suspension) and glycemic control; systemic options if refractory. Other options are less fitting: diphtheria involves adherent gray membranes with systemic toxicity; white spongy nevus is non-scrapable and hereditary; Vincent’s stomatitis targets interdental gingiva with necrosis; chronic hyperplastic candidiasis forms adherent, non-scrapable plaques.