A 41-year-old White man of European and Middle Eastern ancestry with no travel history or unusual exposures was referred in February, 2013 to the Oral Medicine Clinic at Brigham and Women's Hospital (Boston, MA, USA) for the evaluation of mouth ulcers. His notable medical history included depression for which he was currently on fluoxetine and insomnia for which he was on zolpidem. Upon examination, he had a painful and necrotic ulcer with an erythematous halo on the uvula causing dysphagia for the past 4 weeks that subsequently resulted in autoamputation of the uvula approximately 2 years after initial presentation (figure 1).

Kaynak: The Lancet