DIAGNOSTIC CHALLENGES OF ORAL LESIONS IN A PATIENT AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION

Abstract

Oncohematologic patients after hematopoietic stem cell transplantation (HSCT) are at risk of developing opportunistic oral infections and malignant neoplasms. The objective of this report is to describe 3 diagnostic challenges of oral lesions that affected the same posttransplant patient: an atypical herpes simplex virus lesion in ventral tongue, a gingival actinomycosis infection, and later a leukemic infiltration on the soft palate. A 57-year-old female patient first complained of a progressive and painful sublingual nodule for 3 days at D+35 of HSCT by extranodal natural killer/T-cell lymphoma, and final diagnoses were atypical herpes simplex virus 1 and 2 infection. Two months later, ulcerated lesions in the vestibular and palatal gingival margin of the left upper molars were noted, with final diagnosis of Actinomyces sp infection. Fifteen days later, an erythematous lesion with necrotic center was observed in the soft palate, and the diagnosis was palatal infiltration by extranodal natural killer/T-cell lymphoma.