Monday, January 5, 2015

A 47-year-old woman with known HIV/AIDS (CD4+ lymphocyte, 106/μL and viral load,

A 47-year-old woman with known HIV/AIDS (CD4+ lymphocyte, 106/μL and viral load, 35,000/mL) presents with painful growths on the side of her tongue as shown in Figure.


What is the most likely diagnosis?

A. Aphthous ulcers
B. Hairy leukoplakia
C. Herpes stomatitis
D. Oral candidiasis
E. Oral Kaposi’s sarcoma

The answer is B.  Oral hairy leukoplakia is caused by a severe overgrowth of
Epstein-Barr virus infection in T-cell–deficient patients. It is not premalignant and is often
unrecognized by the patient but is sometimes a cosmetic, symptomatic, and therapeutic
nuisance. The white, thickened folds on the side of the tongue can be pruritic or painful
and sometimes resolve with acyclovir derivatives or topical podophyllin resin. Ultimate
resolution occurs after immune reconstitution with antiretroviral therapy. Oral candidiasis
or thrush is a very common, relatively easy-to-treat condition in HIV patients and
takes on an appearance of white plaques on the tongue, palate, and buccal mucosa that
bleed with blunt removal. Herpes simplex virus (HSV) recurrences or aphthous ulcers
present as painful ulcerating lesions. The latter should be considered when oral ulcers persist,
do not respond to acyclovir, and do not culture HSV. Kaposi’s sarcoma is uncommon
in the oropharynx and takes on a violet hue, suggesting its highly vascularized content.

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