Photo Quiz

Rash Inside the Mouth


Am Fam Physician. 2017 Jun 1;95(11):729-730.

A 40-year-old woman presented with a four-day history of sore throat, dry cough, malaise, and myalgia. She did not have red or watery eyes. One day before these symptoms began, she noted a rash on the inside of her mouth. She did not have constitutional symptoms such as fever, chills, or weight changes. She had not been exposed to sick contacts or unimmunized children.

On physical examination, she appeared well and was in no acute distress. There was mild tonsillar hypertrophy with mild erythema and no discharge. A greyish-white vesicular eruption with an erythematous background was noted on the buccal mucosa (Figure 1).

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Figure 1.

Figure 1.


Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Fordyce spots.

B. Herpetic gingivostomatitis.

C. Koplik spots.

D. Oral candidiasis.


The answer is C: Koplik spots. Koplik spots

Author disclosure: No relevant financial affiliations.

Address correspondence to Joseph Aziz, MD, at Reprints are not available from the author.


1. Gan H, Maldonado YA. Measles: clinical manifestations, diagnosis, and treatment [subscription required]. Updated February 2, 2017. Accessed April 28, 2017.

2. Richardson M, Elliman D, Maguire H, Simpson J, Nicoll A. Evidence base of incubation periods, periods of infectiousness and exclusion policies for the control of communicable diseases in schools and preschools [published correction appears in Pediatr Infect Dis J. 2001;20(7):653]. Pediatr Infect Dis J. 2001;20(4):380–391.

3. Centers for Disease Control and Prevention. Measles (rubeola). Accessed January 26, 2017.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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