History

An 89-year-old woman is seen because of a white area on the tongue. She has been hospitalized on a behavioral health unit for 2 weeks; 1 day ago, enoxaparin was begun for a new left leg deep venous thrombosis. Recent antibiotic therapy for a urinary tract infection; candidal vulvitis followed and was treated with topical clotrimazole. Has penicillin allergy.

Physical Examination

Afebrile woman whose mouth hurts. Lucid in discussing symptoms; shows appropriate affect. Local facial swelling. Superficial temporal arteries pulsatile, non-tender, and non-nodular. White area on tongue tender. Unable to remove white material with tongue blade despite vigorous technique.

No regional lymphadenopathy. No skin lesions; preexisting groin mycosis almost completely cleared up. Breathing is easy and quiet; on auscultation air exchange normal, with no crackles or wheezes.