HAIRY LEUKOPLAKIA IN A PATIENT UNDERGOING ANTI-RETROVIRAL THERAPY

Abstract

We report a case of hairy leukoplakia that developed in a patient undergoing anti-retroviral therapy. A 53-year old white male presented with mild erythema in the anterior maxillary gingiva and was managed with clobetasol gel, after excluding the possibility of candidiasis. Patient's medical history was significant for HIV, bipolar disorder, high blood pressure, high cholesterol, chronic bronchitis, smoking, and alcohol. His medications included Androgel, Axiron, atorvastatin, bupropion, clonazepam, finasteride, hydrochlorothiazide, lamotrigine, lisinopril, pantoprazole, Prezcobix, Trazadone, Truvada (200 mg emticitabine, 300 mg tenofovir), Ziprasidone, zolpidem, and baby aspirin. During one of multiple follow-up appointments, an asymptomatic white plaque was identified on right lateral tongue. Clinical differential diagnoses included hairy leukoplakia and hyperkeratosis secondary to trauma. Patient reported that his physician changed Truvada to Descovy (200 mg emticitabine, 25 mg tenofovir) since his last appointment. At the appointment six weeks later, the white plaque increased in size, and additional white plaques were found on the left dorso-lateral surface and dorsal tongue. Two biopsies were taken, one from the right lateral and the other from left dorso-lateral tongue. The biopsies showed similar histological features including hyperparakeratosis with shaggy surface and bacterial colonization. Intracellular edema and pyknotic nuclei were noted in the spinous cell layer. Upper spinous cell nuclei were enlarged and glassy appearing, without obvious nucleoli or nuclear beading. An Epstein-Barr encoding region (EBER) in-situ hybridization was performed, which demonstrated presence of EBV. Blood testing, taken five days after the biopsy, showed a CD4 count and viral load within normal limits. The patient's physician prescribed a course of acyclovir 800mg for treating oral hairy leukoplakia. The oral lesions reduced in size at the follow-up appointment three weeks after completion of acyclovir therapy. Further follow-up information also will be presented.