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Woman with sudden oral discomfort
  1. Suguru Asako1,
  2. Yasuhiro Suyama2,
  3. Manabu Sugita3
  1. 1 Department of Emergency Medicine, JR Tokyo General Hospital, Tokyo, Japan
  2. 2 Division of Rheumatology, JR Tokyo General Hospital, Tokyo, Japan
  3. 3 Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
  1. Correspondence to Dr Suguru Asako, Department of Emergency Medicine, JR Tokyo General Hospital, Tokyo, Japan; asako.jre{at}

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Clinical introduction

A 76-year-old woman presented to the ED from a French restaurant complaining of a sudden onset of oral discomfort that developed 1 hour after having a hot soup. Physical examination showed a 3×3 cm bullous haematoma on her soft palate (figure 1). She had repeated similar episodes of intraoral haematomas after meals, but other parts of the body had never been involved. Laboratory results were white blood cell count of 9000/mm3, haemoglobin 14.3 g/dL and platelet count 259 000/mm3. Coagulation tests of APTT and PT-INR were within the normal range.

Figure 1

A 3 × 3 cm bullous hematoma on her soft palate on admission.


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  • Contributors According to the definition given by the International Committee of Medical Journal Editors, the following individuals qualify for authorship based on their substantial contributions to the manuscript’s intellectual content: SA was involved with conception and design; SA and YS participated in writing the manuscript. All authors read and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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