Severe Presentation and Delayed Intervention in Herpetic Gingivostomatitis.

Herpetic gingivostomatitis (HGS) is a common manifestation of herpes simplex virus type 1 (HSV-1) infection in children and is usually mild and self-limiting. We report the case of an eight-year-old boy with a known history of developmental delay who presented with prolonged fever and painful oral ulcers. The patient presented eight days after symptom onset. The lesions rapidly spread to involve the lips, tongue, and buccal mucosa, forming thick hemorrhagic crusts. He developed severe anemia that required transfusion and failed to improve with topical acyclovir and antibiotics. Upon presentation to our hospital, intravenous acyclovir was started with supportive therapy. His condition improved markedly, and the lesions resolved. This case describes an unusual, severe, hemorrhagic presentation of HGS in an immunocompetent child. It highlights that systemic antiviral therapy can lead to clinical improvement even when initiated later in the disease course and underscores the need for further studies to define optimal management for severe cases.