Recurrent oral ulceration associated to group Aβ-hemolytic streptococcus reinfection in a post-rheumatic heart disease patient

Recurrent oral ulceration (rou) presents as recurrent,round ulcers of yellow or grey surface,single or multiple,with erythematous halo. rou associated with systemic diseases such as infection,immune defects and degenerative diseases. rheumatic heart disease (rhd) was a cardiovascular disease due to non-suppurative complications of group aβ-hemolytic streptococcus (gas) caused by delayed immune response. oral streptococci has been suggested to play important role in oral ulceration. this article reviewed a case of rou associated to reinfection of gas in post-rhd patient. a 21 year female complained of highly rou which almost never healed since her teenage years. she was diagnosed with rhd at 9 years old and underwent treatment until 15 years old. oral ulcers treated with combination of topical anti-inflammatory and antiseptic. oral hygiene improved by scalling and root planning treatment. complete blood count and anti-streptolysin titer o (asto) tests resulted in 3200 iu/ml of titer (n < 200 iu/ml). referral to the cardiologist was made to confirm rhd reactivation. patient treated with penicillin g benzathine injection monthly for a year and advised to avoid tooth extraction. gas infection plays a role in the recurrence of oral ulceration and should not be mistreated as recurrent ulcers of other origins.