Oral hairy leukoplakia as an early indicator of Epstein-Barr virus–associated post-transplant lymphoproliferative disorder

Abstract

Oral hairy leukoplakia (OHL) was first identified in 1984 in homosexual males infected with the human immunodeficiency virus (HIV). 1 Greenspan D Greenspan JS Conant M et al. Oral “hairy” leucoplakia in male homosexuals: Evidence of association with both papillomavirus and a herpes-group virus. Lancet. 1984; 2: 831 Abstract PubMed Scopus (310) Google Scholar The condition is characterized by adherent, white, corrugated plaques, appearing most often on the lateral borders of the tongue. Although the lesions are usually asymptomatic and require no treatment, they may be superinfected by Candida albicans and produce burning symptoms. 2 Ficarra G Barone R Gaglioti D et al. Oral hairy leukoplakia among HIV-positive intravenous drug abusers: A clinicopathologic and ultrastructural study. Oral Surg Oral Med Oral Pathol. 1988; 65: 421 Abstract Full Text PDF PubMed Scopus (60) Google Scholar OHL is a result of infection with Epstein-Barr virus (EBV), a member of the herpesvirus family. Although originally thought to be specific to those with HIV infection, the lesions have also been seen in patients with other forms of immunosuppression. These include those who have undergone solid organ 3 Greenspan D Greenspan JS de Souza Y et al. Oral hairy leukoplakia in an HIV-negative renal transplant recipient. J Oral Pathol Med. 1989; 18: 32 Crossref PubMed Scopus (85) Google Scholar and bone marrow transplantation 4 Epstein JB Sherlock CH Wolber RA Hairy leukoplakia after bone marrow transplantation. Oral Surg Oral Med Oral Pathol. 1993; 75: 690 Abstract Full Text PDF PubMed Scopus (33) Google Scholar and patients treated with steroids. 5 Lozada-Nur F Robinson J Regezi JA Oral hairy leukoplakia in nonimmunosuppressed patients: Report of four cases. Oral Surg Oral Med Oral Pathol. 1994; 78: 599 Abstract Full Text PDF PubMed Scopus (36) Google Scholar The lesions have also been documented on rare occasions in immunocompetent individuals. 5 Lozada-Nur F Robinson J Regezi JA Oral hairy leukoplakia in nonimmunosuppressed patients: Report of four cases. Oral Surg Oral Med Oral Pathol. 1994; 78: 599 Abstract Full Text PDF PubMed Scopus (36) Google Scholar , 6 Eisenberg E Krutchkoff D Yamase H Incidental oral hairy leukoplakia in immunocompetent persons: A report of two cases. Oral Surg Oral Med Oral Pathol. 1992; 74: 332 Abstract Full Text PDF PubMed Scopus (43) Google Scholar Presented here is a case where OHL was an early indication of EBV-associated posttransplant lymphoproliferative disorder (PTLD).