Abstract
Oral ulcerations in HIV infection pose challenges to diagnosis because of the associated diversity of pathologic alterations and etiologic agents. The final diagnosis of nonspecific oral ulcerations is achieved by excluding infections or neoplastic processes. A 48-year old man with HIV infection refractory to highly active antiretroviral therapy presented with a CD4 count of 13 cells/mm3 and complaints of epigastric pain, weakness, and weight loss. Endoscopic examination showed deep ulcers in the esophagus and stomach. Intraoral examination revealed painful ulcerative metachronous lesions in the mouth floor and soft palate. The differential diagnosis included viral or fungal infection, lymphoma, and squamous cell carcinoma; incisional biopsy and histopathologic analysis were not conclusive. Serology, polymerase chain reaction, and immunohistochemistry were also negative for cytomegalovirus, Epstein-Barr virus, and herpes simplex virus 1 and 2. Thalidomide treatment resulted in resolution of oral lesions. This case shows the importance of the dental team in the diagnosis of oral lesions in patients with HIV infection.
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