A 42-year-old female with a history of lymphoma is sent to an Infectious Disease physician for recurrent mouth ulcers. Her oncologist had done a CBC, CMP, and CXR, which were normal. Swabs for Herpes simplex PCR were obtained. A course of Valtrex had not improved the ulcers to date. Previous episodes of these ulcers had happened and usually recurred spontaneously after four weeks or so.

Before the visit to the ID physician, she developed fevers and gastrointestinal bleeding; there were ulcers in parts of her upper and lower GI tracts. A gastroenterologist prescribed steroids, which improved the GI bleeding and the mouth ulcers as well.