Oral hair leukoplakia K13.3

Greenspan et al., 1984h

Clinically characteristic whitish changes of the tongue mucosa described in the context of HIV infection. However, the clinical picture can also be observed in non-HIV patients.

• In about 18% of HIV-infected and 36% of AIDS patients.
• Also in kidney or bone marrow transplant patients under immunosuppression
• More common in patients who use steroid inhalers for long periods of time due to pulmonary problems
• Patients with autoimmune diseases that are under long-term immunosuppressive therapy (coincidence with candia infections)

Infection with EBV viruses.

Tongue

Several millimetres thick, white, mostly asymptomatic, non-wipeable mat-like deposits on the lateral edge of the tongue and the lower surface of the tongue.

Hyperparakeratosis with hair-like projections on the surface. Large, ballooned cells with pynotic nuclei. Lack of dermal inflammatory response. Electron microscopic and immunohistochemical evidence of Epstein-Barr virus in the lesions.

Oral leukoplakia; lichen planus; candidiasis; exfoliatio areata linguae; pseudo-hair leukoplakia.

If necessary, brush off and vitamin C (e.g. Cebion) Tbl. 400-1000 mg/day, let Tbl. melt on the tongue. In cases of severe suffering, therapy with acyclovir (e.g. Zovirax) 5 times/day 400 mg p.o. is possible. This includes rapid regression of the hair leukoplakia, but after discontinuation, it often leads to rapid recurrence. Alternatively, Valaciclovir (Valtrex) 3 times/day 1 g p.o. (off-label use; according to studies well effective, lower risk of relapse than under Aciclovir).

Depends on the underlying disease; 80% of patients develop full-blown AIDS within 1-2 years after the onset of oral hair leukoplakia

Case report (Bogner R (2024 HIV | MMW Blickdiagnose)
A 57-year-old man with a salmonella infection of the urinary tract complained of a weight loss of 8 kg and a bland taste in his mouth. A subsequent HIV test was positive. A look at the tongue revealed the following findings:

A flat carpet-like whitish coating in which masses of Candida species were detectable. A rather inconspicuous but important finding was shown in smaller, firm papules and plaques on the edge of the tongue (S-figure with yellow arrow).

The diagnosis was: oral hairy leukoplakia in advanced HIV infection.

The tongue finding was the reason for the immediate start of a combination antiretroviral therapy with dolutegravir and lamivudine as well as a therapy with fluconazole - even before the first laboratory results were available. The patient's sense of taste normalized after just one week.

The laboratory confirmed the suspicion of an already advanced HIV infection: the CD4 cell count was only 33/µl (10% of all peripheral lymphocytes), the HIV quantification revealed 1.16 million RNA copies per ml.

1. Bogner R (2024) HIV | Gaze diagnosis - Typical sign of AIDS on the tongue. MMW - Fortschritte der Medizin | Special Issue 2/2024

2. Chambers AE et al. (2014) Twenty-first-century oral hairy leukoplakia--a non-HIV-associated entity. Oral Surg Oral Med Oral Pathol Oral Radiol 119:326-332

3. Greenspan D et al. (2004) Incidence of Oral Lesions in HIV-1-infected Women: Reduction with HAART. J Dent Res 83: 145-150
4. Greenspan D, Greenspan JS et al. (1984) Oral "hairy" leucoplakia in male homosexuals: evidence of association with both papillomavirus and a herpes-group virus. Lancet 2: 831-834
5. Greenspan JS, Greenspan D et al. (1985) Replication of Epstein-Barr virus within the epithelial cells of oral "hairy" leukoplakia, an AIDS-associated lesion. N Engl J Med 313: 1564-1571
6. Greenspan D (1985) Oral viral leukoplakia ("hairy" leukoplakia): a new oral lesion in association with AIDS. Compend Contin Educ Dent 6:204-206
7. Madeley CR (1984) Viruses and oral "hairy" leucoplakia. Lancet 2: 1279
8. Itin P et al (1991) Oral hairy leukoplakia in renal transplant patients. Dermatology 42: 487-491
9. Walling DM et al. (2003) Epstein-Barr virus replication in oral hairy leukoplakia: response, persistence, and resistance to treatment with valacyclovir. J Infect Dis 188: 883-890
10. Winzer M et al. (1988) Hairy lesions of the oral cavity. Am J Dermatopathol 10: 155-159