prompt consideration of immune status, as it is more common in patients with human immunodeficiency virus (HIV) or other immunosuppressed states Fungal infection may also present as a well-circumscribed area of papillary atrophy in the central tongue, termed median rhomboid glossitis It is generally asymptomatic, but often responds to antifungals if necessary Primary infection with the herpes simplex virus (HSV), especially type (HSV-1) commonly presents in young children or infants as herpes gingivostomatitis It causes painful vesicles, erosions, ulcerations, and erythema on the gingiva, mucosa, and perioral tissue, often with fever, poor oral intake, and drooling Recurrent disease manifests as herpes labialis or “cold sores,” painful vesicular lesions on or around the lips Lesions may be triggered by acute febrile illnesses, sun exposure, or stress