A lesion, or sore, on a child’s tongue accompanied with a fever may be signs of serious illness. Several strains of bacteria, including staphylococcus and streptococcus species, are known to cause lesions in the mouth. Additionally, these clinical manifestations may be indicative of a genetic disorder, such as Kawasaki disease. Consult a physician immediately any time such symptoms are present.

Kawasaki Disease

Kawasaki disease (KD) is an autoimmune disorder, where the body’s immune system targets its own tissues and cells. In KD, the blood vessels become swollen and the cellular linings of the vessels begin to die. Affected children often have a fever and lesions on the tongue and the mucosal lining of the mouth in a condition called “strawberry tongue.” An article in the February 2011 issue of the “Indian Journal of Pediatrics” described a case of KD in which a 5-year-old child presented with a fever, strawberry tongue and abdominal pain. The child was unresponsive to antibiotics and the abdominal pain continued and distension of the abdomen worsened. Afterward, the fever diminished and other symptoms cleared.

Primary Herpetic Gingivostomatitis

Primary herpetic gingivostomatitis (PHG) is a condition that occurs in children and young adults caused by the herpes simplex virus 2.

Congenital Insensitivity to Pain

An article in the October 2008 issue of “Dental Traumatology” described a case of a 2-year-old girl with congenital insensitivity to pain with anhidrosis, which is a genetic disorder where the body fails to produce sweat and is characterized by a recurrent unexplained fever. The physicians noted that this child also had sores, or lesions, on her tongue, lips and cheeks. Congenital insensitivity to pain will allow a young child to unconsciously self-mutilate due to the failure of pain receptors to initiate a response in the brain and prevent these actions.

Recurrent Toxin-Mediated Perineal Erythema

Recurrent toxin-mediated perineal erythema (RTPE) is an infection of the skin caused by staphylococci and streptococci bacteria 1. An article in the February 2008 issue of the “Archives of Dermatology” described 11 cases of RTPE occurring in children 1. The authors noted that seven of the patients appeared with discoloration and lesions of the tongue and fever. The physicians treated the children with antibiotics for 10 days for a hemolytic streptococcal infection, which causes the splitting, or lysis, of cells. The study noted, however, that three of the patients had recurrent rashes during follow-up examinations.