EPSTEIN-BARR VIRUS–POSITIVE MUCOCUTANEOUS ULCER: A CASE REPORT

Abstract

Epstein-Barr virus–positive mucocutaneous ulcer (EBVMCU) is a newly recognized clinicopathologic entity included in the group of mature B-cell neoplasms in the 2017 revision of World Health Organization Classification for Lymphoproliferative Disorders. A nonsmoking 92-year-old man presented with an ulcerated lesion on the maxillary alveolar ridge. An incisional biopsy was performed and reported an undifferentiated malignancy composed of cell clusters with scarce cytoplasm and very pleomorphic nuclei. The immunohistochemical profile expressed CD20, CD30, CD15, CD45 and Epstein-Barr virus-encoded latent membrane protein (EBV-LMP) antigens, consistent with EBVMCU. Within 2 weeks, the lesion became painful and the palate was infiltrated. Tomography showed loss of bone tissue and permeative aspect in the right maxilla. After 8 weeks of rituximab, the patient was asymptomatic and presented regression of the lesion, maintaining only the bone exposed area. This case highlights that proper clinical history and ancillary studies can avoid misinterpretation and overtreatment of EBVMCU oral lesions. Epstein-Barr virus–positive mucocutaneous ulcer (EBVMCU) is a newly recognized clinicopathologic entity included in the group of mature B-cell neoplasms in the 2017 revision of World Health Organization Classification for Lymphoproliferative Disorders. A nonsmoking 92-year-old man presented with an ulcerated lesion on the maxillary alveolar ridge. An incisional biopsy was performed and reported an undifferentiated malignancy composed of cell clusters with scarce cytoplasm and very pleomorphic nuclei. The immunohistochemical profile expressed CD20, CD30, CD15, CD45 and Epstein-Barr virus-encoded latent membrane protein (EBV-LMP) antigens, consistent with EBVMCU. Within 2 weeks, the lesion became painful and the palate was infiltrated. Tomography showed loss of bone tissue and permeative aspect in the right maxilla. After 8 weeks of rituximab, the patient was asymptomatic and presented regression of the lesion, maintaining only the bone exposed area. This case highlights that proper clinical history and ancillary studies can avoid misinterpretation and overtreatment of EBVMCU oral lesions.