A Case of Secondary Syphilis Presenting as a "Leukoplakia-like" Plaque on the Tongue in a HIV Patient / 대한피부과학회지

"Leukoplakia-like" plaque on the tongue is an uncommon skin manifestation of secondary syphilis. Skin lesions of secondary syphilis usually have numerous presentations, which mimic many other skin diseases, especially in the presence of HIV co-infection. Oral hairy leukoplakia (OHL) is characterized by corrugated whitish patches and plaques on the lateral border of the tongue. It is frequently and strongly associated with HIV but may appear in other diseases. A 47-year-old man with HIV and receiving HAART therapy developed a leukoplakia-like plaque on the tongue, which was first suggestive of OHL but was eventually diagnosed as secondary syphilis.

Leucoplasia pilosa bucal: presentación de caso clínico / Bucal hairy leukoplakia: a case report

Se presenta caso clínico de paciente con lesiones blanquecinas en bordes laterales de lengua de 1 año de evolución aproximadamente; clínicamente asintomático, sin hábitos tóxicos ni antecedentes médicos de importancia. Actualmente bajo tratamiento ortodóntico, en donde el especialista lo alerta sobre la importancia de interconsultar con el Patólogo Bucal. Luego de una exhaustiva historia clínica, se toma muestra de la lesión y el examen histopatológico arrojó: hiperplasia epitelial exofítica, paraqueratosis excesiva y células superficiales en forma de globo con típica fragmentación nuclear, indicativo de inclusión viral (Cuerpos de Cowdry). Con estos hallazgos, la correlación con las características clínicas de la lesión y los exámenes serológicos (positivo para VIH), se llega a un diagnóstico conclusivo de Leucoplasia Pilosa Bucal (LPB). Se remitió el paciente al Instituto Anzoatiguense de la Salud (SALUDANZ), entidad encargada de problemas de Salud Pública en el Edo. Anzoátegui. La Leucoplasia Pilosa Bucal (LPB) se presenta comúnmente en pacientes VIH+ y representa un factor informativo y predictivo para el odontólogo, estomatólogo y cualquier especialista de la rama de la salud, en cuanto al tratamiento, diagnóstico y pronóstico bucal y sistémico del paciente.

We report the clinical case of a patient with whitish lesions on lateral tongue edges with 1 year of evolution approximately, clinically asymptomatic, without toxic habits or important medical history. The patient was in orthodontic treatment, when the specialist warns the importance of Bucal Pathologist review. After a thorough medical history, biopsy was taken and histopathological examination showed: exophytic epithelial hyperplasia, excessive parakeratosis and superficial balloon cells with typical nuclear fragmentation, indicative of viral inclusion (Cowdry Body´s). With these findings and correlation with lesion clinical features and serological tests (HIV positive), the final diagnosis was Bucal Hairy leukoplakia (OHL). The patient was referred Anzoatiguense Health Institute (Saludanz), entity responsible of public health problems in the Anzoátegui State, Venezuela. The Bucal Hairy Leukoplakia (OHL) occurs commonly in HIV patients and represents an informative and predictive factor for the dentist, stomatologist and any health branch specialist for treatment, diagnosis and prognosis of the patient.

Frecuencia de lesiones en cavidad oralde pacientes con VIH/sida en el Hospital Universitario San Ignacio de Bogotá, Colombia (2005-2010) / Frequency of mouth diseases in HIV/Aids patients from San Ignacio University Hospital, Bogota, Colombia (2005-2010)

Objetivo: determinar la frecuencia de las lesiones orales que se presentaron en los pacientescon VIH/sida que asistieron a la Unidad de Infectología del Hospital UniversitarioSan Ignacio en Bogotá, Colombia, en el periodo 2005-2010. Métodos: se realizó un estudioobservacional descriptivo con una muestra de 180 de un total de 1600 historias clínicas.Los criterios de inclusión fueron historias clínicas de pacientes con VIH/sida mayores de18 años de edad. Se excluyeron las historias clínicas de pacientes que no presentaban losresultados del conteo de linfocitos T CD4+. Los hallazgos se analizaron descriptivamentepor medio de distribuciones de frecuencia y promedios. Resultados: la frecuencia generalde lesiones orales fue del 47,8 %. La lesión oral más frecuente fue la candidiasis seudomembranosa(12,8 %), seguida por leucoplasia vellosa (5 %) y herpes simple (4,4 %). En elanálisis la presencia de lesiones orales se asoció un conteo promedio de linfocitos T CD4+de 135 células/mm3. Conclusiones: las lesiones orales más frecuentes fueron candidiasisoral seudomembranosa, leucoplasia vellosa y herpes simple. La disminución de células TCD4+ se asocia con la aparición de lesiones orales...

Objective: To determine the frequency of mouth diseases in HIV/aids patients attending theInfectious Disease Unit of the San Ignacio University Hospital in Bogota, Colombia, during2005-2010. Methods: A descriptive study with a sample of 180 out of 1600 clinical recordswas carried out. Criterion for inclusion in the study was patients 18 years of age. Recordswithout T-lymphocyte (CD4) count were excluded. Data were analyzed descriptively throughfrequency distribution and averages measures. Results: Mouth diseases were reportedin 47.8 % of the records. The most common lesion was pseudomembranous candidiasis(12.8 %), followed by hairy leukoplakia (5 %) and herpes simplex (4.4 %). Mouth diseases wereassociated with an average CD4 count of 135/mm3. Conclusion: Oral pseudomembranouscandidiasis, hairy leukoplakia and herpes simplex were the most frequent diseases. A decreasein CD4 cell count is associated with mouth diseases...

Human papillomavirus and Epstein Barr virus in oral hairy leukoplakia among HIV positive Venezuelan patients

Oral hairy leukoplakia (OHL) is commonly found in individuals infected with HIV, and represents the most frequent oral manifestation. The purpose of this study was to detect the presence of Human Papillomavirus (HPV) and Epstein Barr Virus (EBV) in OHL of HIV+ Venezuelan patients. We evaluated 21 HIV+ adult patients with clinically present OHL lesions: 11 under antiretroviral therapy, 10 without therapy, and 10 oral mucosal samples as controls. Nested-PCR was used to detect EBV and HPV infection. The INNO-LiPA HPV Genotyping v2 was applied to determine the HPV genotype. The EBV genome was found in 16/21 (76%) of the HIV+ patients with OHL. No difference was observed in EBV+ and EBV- patients related to antiretroviral therapy viral load and CD4+ T cell count. HPV-DNA was observed in 7/21 HIV positive cases (33%). The HPV genotypes detected were: 6, 11, 31, 33, 52, and 56/74. The most frequently HPV found was genotype 6 in 7/7, while two cases were HPV-11 and two HPV-52. Of the positive cases, 5/7 (71%) presented co-infection with more than one HPV genotype and 4/7 (57%) had HPV coinfection with high and low risk types. No case was EBV or HPV positive in the control group. In this study, a higher EBV prevalence was observed in OHL-HIV+ patients, confirming the etiologic role in this entity. A considerable number of cases were positive for HPV infection, and many patients presented coinfection with more than one HPV genotype as well as the presence of high oncogenic risk HPV in OHL.

El proposito del presente estudio fue detectar la presencia de virus papiloma humano (VPH) y Epstein Barr (VEB) en Leucoplasia Vellosa Oral (LVO) de pacientes VIH positivos. Se evaluaron 21 pacientes adultos VIH positivos con lesiones clinicas presentes de LVO y 10 casos controles de mucosa sana. Para el diagnostico molecular de VPH y EBV se utilizo Nested PCR. La determinacion de los genotipos se realizo mediante el kit HPV INNO-LiPA genotyping v2. La presencia de genoma de VEB se demostro en un alto porcentaje (76%) en 16/21 de los pacientes VIH positivos con LVO. No se observo relacion entre los pacientes VEB+ y VEBcon el uso de terapia antirretroviral, la carga viral y el contaje de celulas T CD4+. Se demostro la presencia de ADN-VPH en 7/21 (8%) de los casos VIH positivos. Los genotipos de VPH detectados fueron 6, 11, 31, 33, 52, 56/74. El genotipo 6 fue el mas frecuentemente observado en 7/7, dos casos fueron VPH 11 y dos VPH 52. De los casos positivos 5/7 (71%) presentaron coinfeccion con mas de un genotipo de VPH y en 4/7 (57%) se evidencio coinfeccion con tipos de alto y bajo riesgo oncogenico. En el presente estudio se observo una alta prevalencia de VEB en pacientes VIH positivos con LVO, confirmando el papel etiologico en esta entidad. Un considerable numero de casos fueron positivos para VPH. Se observo la presencia de coinfeccion con mas de un tipo viral, asi como la presencia de VPH de alto riesgo.

Tratamento da leucoplasia pilosa: revisão da literatura / Treatment of oral hairy leukoplakia: a literature review

Introdução: Pacientes com imunosupressão pela infecção do HIV (Human Immunodefi ciency Vírus) freqüentemente desenvolvem lesões de boca como a leucoplasia pilosa (LP). LP é uma lesão quase que exclusivamente observada em indivíduos infectados pelo HIV que apresentam uma baixa contagem de linfócitos T CD4. LP é assintomática e aparece como placa branca na borda lateral da língua, de superfície plana, corrugada ou pilosa e não removível quando raspada. A etiologia da LP é relacionada ao vírus Epstein-Barr, que pode ser identificado através de técnicas de microscopia eletrônica, hibridização "in situ", imunoistoquímica e reação em cadeia da polimerase. A citologia esfoliativa é uma boa opção para o diagnóstico da LP, por ser um método simples, confiável, seguro, não invasivo e não traumático. O tratamento da LP é recomendado para eliminar as pilosidades, restaurar o conforto do paciente, re-estabelecer as características normais da língua e eliminar nichos de bactérias, vírus e fungos desencadeadores de outras doenças da boca. Os tratamentos propostos na literatura para LP incluem cirurgia, terapia anti viral sistêmica e a terapia tópica. Objetivo: Realizar uma revisão de literatura sobre as opções de tratamento para a LP. Conclusão: A terapia tópica tem sido a mais recomendada, por ser de fácil aplicação, pouco invasiva, de baixo custo, com poucos efeitos colaterais e, principalmente, para eliminar as pilosidades e EBV, para restabelecer as características normais da língua sem desenvolvimento de resistência aos vírus e para eliminar nichos bacterianos e fúngicos. Indicações clínicas para esse tratamento devem incluir sintomas associados à lesão ou um desejo do paciente, por razões estéticas de eliminar a lesão.

Introduction: Patients with immunosupression caused by the human immunodeficiency virus (HIV) infection frequently develop oral lesions such as oral hairy leukoplakia (OHL). OHL is a lesion almost exclusively observed in HIV-infected individuals, who present low T CD4 lymphocyte count. OHL is asymptomatic and appears as a white plaque on the lateral border of the tongue, with fl at, corrugated or hairy surface, which is not detachable when scraped. The etiology of OHL is related to Epstein-Barr virus, which may be detected by electron microscopy, in situ hybridization, immunohistochemistry, and polymerase chain reaction techniques. Exfoliative cytology is a good option for the diagnosis of OHL, for being a simple, reliable, safe, noninvasive and non-traumatic method. The treatment of OHL is recommended to eliminate the filiform structures on lesion surface, provide comfort to the patient, re-establish the normal characteristics of the tongue and eliminate possible niches for bacteria, viruses and fungi that may cause other oral diseases. The treatments proposed in the literature for OHL include surgery, anti viral systemic therapy and topical therapy. Objective: This paper presents a literature review about the treatment options for OHL. Conclusion: Topical therapy has been the most recommended because it is easy to apply, is a low-invasive and low-cost procedure, and has few side effects. It is mainly indicated for removing the filiform structures on lesion surface, eradicating the Epstein-Barr virus, reestablishing the normal characteristics of the tongue without developing resistance to the virus, and eliminating bacterial and fungal niches. Clinical indications for this treatment should include symptoms associated with the lesion or the patient's desire of eliminating the lesion for esthetic reasons.

Detección de Candida Albicans en lesiones de leucoplasia vellosa bucal de un grupo de pacientes venezolanos VIH+ / Detection of candida albicans in lesions of oral hairy leukoplakia a group of HIV + patients in Venezuela

El objetivo del presente estudio fue determinar la prevalencia de la infección por Candida albicans en lesiones de Leucoplasia Vellosa Bucal (LVB) en un grupo de pacientes VIH+ en una muestra de la población venezolana. Para ello se evaluaron 21 pacientes adultos VIH+, con lesiones clínicas de Leucoplasia Vellosa Bucal, 11 con terapia antiretroviral y 10 sin terapia, y 10 pacientes adultos VIH- con lesiones hiperqueratósicas de la mucosa oral provenientes del Centro para la Atención de Pacientes con Enfermedades Infectocontagiosas de la Facultad de Odontología de la Universidad Central de Venezuela. Los pacientes fueron examinados clinícamente para la detección de lesiones presentes en la mucosa oral, confirmándose el diagnóstico con el estudio histopatológico. La infección por C albicans se determinó mediante biopsias de las lesiones para su estudio histopatológico empleando dos técnicas diferentes, coloración de Pass y método de Grocott, y cultivo microbiológico en medio Agar Sabouraud Resultados: En pacientes VIH+ según los distintos métodos empleados se pudo observar que mediante el cultivo en Agar Sabouraud 6/21 (29%) de los pacientes fueron positivos y 15/21 (71%) fueron negativos. Con respecto a la coloración de Grocott, todos los 21 pacientes fueron positivos, mientras que con la coloración de PAS, 17/21 (81%) de los pacientes fueron positivos y 4/21 (19%) fueron negativos. En el caso de los pacientes VIH- con leucoplasia bucal, 1/10 (10%) resultó positivo mediante el cultivo en Agar Sabouraud y 9/10 (90%) fueron negativos. Mediante la coloración de Grocott todos los pacientes (10) fueron negativos para la presencia del hongo, e iguales resultados fueron obtenidos con la coloración de PAS. Conclusión: Se observó una mayor prevalencia de la infección por C. albicans en pacientes VIH+ lo que demuestra que la presencia del hongo, constituye un factor fuertemente asociado a los pacientes con LVB

The aim of this study was to determine the prevalence of Candida albicans infection in Oral Hairy Leukoplakia (OHL) in Venezuelan HIV+ population. We evaluated 21 HIV+ adults patients with the clinical diagnosis of OHL, 11 under antiretroviral therapy, 10 without and 10 HIV negative adults with hyperkeratotic lesions on the oral mucosa as a control group, from the Center of Infectious diseases, Faculty of Dentistry, Central University of Venezuela. All patients were clinically examined and definitive histopathological diagnosis was made. C albicans was detected by two different histochemical methods: PAS and Groccot and microbiological culture using Agar Sabouraud medium. The results demonstrated that 6/21 (29%) patients were positive by microbiological culture and 15/21 (71%) were negative. All the patients were positive by Grocott special stain while 17/21 (81%) were positive using PAS. In the control group, 1 patient was positive by culture and 9/10 (90%) were negative. Additionally, all the patients were negative by Grocott and PAS. In conclusion, we observed a higher prevalence of C. albicans infection in HIV+ patients, suggesting that the presence of this microorganism may constitute an associated factor in OHL

Oral Hairy Leukoplakia Which Occurred as a Presenting Sign of Acute Myeloid Leukemia in a Child

Oral hairy leukoplakia (OHL) is caused by the reactivation of a previous Epstein-Barr virus (EBV) infection in the epithelium of the tongue. Most lesions are characterized by corrugated whitish patches on the lateral border of the tongue. It is frequently associated with AIDS, but cases in patients with other immunosuppressed states have also been reported. In leukemia patients, OHL is rarely encountered, and appears only after chemotherapy. We report a case of OHL which occurred as a presenting sign of acute myeloid leukemia (AML) in a previously healthy 15-year-old child. A 15-year-old boy presented with a whitish patch on the left lateral border of the tongue. The biopsy specimen revealed papillomatosis, hyperkeratosis, acanthosis and ballooning degeneration in the stratum spinosum. The patient was EBV seropositive, and PCR analysis of EBV DNA in the lesional tissue was positive. After the diagnosis of OHL in dermatologic department, the patient was referred to pediatrics due to the abnormal peripheral blood smear, and was diagnosed with AML.

Polymerase chain reaction genotyping of Epstein-Barr virus in scraping samples of the tongue lateral border in HIV-1 seropositive patients

The Epstein-Barr virus (EBV) is the etiological agent of oral hairy leukoplakia (OHL), an oral lesion with important diagnostic and prognostic value in acquired immunodeficiency disease syndrome. The two EBV genotypes, EBV-1 and EBV-2, can be distinguished by divergent gene sequences encoding the EBNA-2, 3A, 3B, and 3C proteins. The purpose of this study was to identify the EBV genotype prevalent in 53 samples of scrapings from the lateral border of the tongue of HIV-1 seropositive patients, with and without OHL, and to correlate the genotypes with presence of clinical or subclinical OHL with the clinic data collected. EBV-1 and EBV-2 were identified through PCR and Nested-PCR based on sequence differences of the EBNA-2 gene. EBV-1 was identified in the 31 samples (15 without OHL, 7 with clinical OHL and 9 with subclinical OHL), EBV-2 in 12 samples (10 without OHL, 1 with clinical and 1 subclinical OHL), and a mixed infection in 10 samples (2 without OHL, 3 with clinical and 5 with subclinical OHL). The presence of EBV-1 was higher in women, but a significant statistical result relating one the EBV genotypes to the development of OHL was not found. We conclude that the oral epithelium in HIV-1 seropositive patients can be infected by EBV-1, EBV-2 or by a mixed viral population.