EPSTEIN-BARR–POSITIVE ULCERS OF THE ORAL CAVITY ASSOCIATED WITH IMMUNOSUPPRESSION IN A PATIENT WITH CANCER

Abstract

A 24-year-old man with synovial sarcoma was hospitalized for neutropenic fever after chemotherapy, complaining of gingival pain for 1 day. No lymph node involvement was detected during neck palpation. Intraoral exam revealed a purple lesion involving the attached gingiva on the maxilla and mandible, of increased size and with a detachable overlying white plaque. There was rapid evolution to ulcerated lesions, causing an inability to feed. We performed an incisional biopsy and referred the patient for anatomopathologic examination, polymerase chain reaction (PCR), and culture for fungi and bacteria, a prescription of chlorhexidine 0.12%, and empiric fluconazole and acyclovir. PCR was positive for Epstein-Barr virus (EBV) with 1095 copies, so the patient was maintained on acyclovir for 15 days. The patient had significant improvement in pain and the oral lesions regressed after this period. This case demonstrated that EBV commonly occurs in immunosuppressed patients and underscores the importance of dentists in the diagnosis and control of oral complications in the multiprofessional hospital team. A 24-year-old man with synovial sarcoma was hospitalized for neutropenic fever after chemotherapy, complaining of gingival pain for 1 day. No lymph node involvement was detected during neck palpation. Intraoral exam revealed a purple lesion involving the attached gingiva on the maxilla and mandible, of increased size and with a detachable overlying white plaque. There was rapid evolution to ulcerated lesions, causing an inability to feed. We performed an incisional biopsy and referred the patient for anatomopathologic examination, polymerase chain reaction (PCR), and culture for fungi and bacteria, a prescription of chlorhexidine 0.12%, and empiric fluconazole and acyclovir. PCR was positive for Epstein-Barr virus (EBV) with 1095 copies, so the patient was maintained on acyclovir for 15 days. The patient had significant improvement in pain and the oral lesions regressed after this period. This case demonstrated that EBV commonly occurs in immunosuppressed patients and underscores the importance of dentists in the diagnosis and control of oral complications in the multiprofessional hospital team.