What is the most likely diagnosis for a patient with multiple white lesions on the tongue accompanied by fever?

The most likely diagnosis for a patient presenting with multiple white lesions on the tongue along with fever is primary herpetic stomatitis. This condition is caused by the herpes simplex virus, typically HSV-1, and is most common in children but can also occur in adults.

In primary herpetic stomatitis, the initial infection can lead to a systemic response characterized by fever, malaise, and pharyngitis. The presence of multiple white lesions, often seen in the form of vesicles that may ulcerate, is a hallmark of this condition. These lesions can be very painful and make eating and drinking difficult for the patient.

Understanding the systemic symptoms, like fever, alongside the presentation of lesions helps solidify the diagnosis as primary herpetic stomatitis, which is distinct from the other conditions listed. For instance, secondary herpetic stomatitis typically recurs after the initial infection has resolved and might not present with the same systemic symptoms or multiple lesions. Herpangina is usually characterized by small, painful vesicles located primarily on the soft palate and is often associated with enteroviruses rather than herpes simplex virus. Recurrent aphthous stomatitis, while it may present with painful lesions, does not typically involve fever and the lesions appear