A 16-year-old African American girl presents with extremely painful recurrent oral ulcers over the past 2 months. She reports similar painful ulcers of the genital area that have whitish discharge and intermittent low-grade fevers. A recent complaint of blurry vision prompted a visit to an ophthalmologist, who prescribed eye drops for “inflammation.” She denies sexual activity, drug use, nausea, vomiting, diarrhea, headaches, rash, joint pains, cough, or frequent infections. Her past medical history is unremarkable, but an older brother has human immunodeficiency virus (HIV) infection.

Physical examination reveals a well-developed adolescent girl in no acute distress. Her vital signs are within age-appropriate limits. She has several well-demarcated aphthous ulcers in her buccal mucosa and oval ulcers with whitish discharge over her labia majora. The remainder of the physical examination yields no findings of note.

Laboratory testing reveals normal findings on a complete metabolic panel, urinalysis, and serum immunoglobulin and complement...

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