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Oral Hairy Leukoplakia

Clinical Case

Case 1

  • 37-year-old male with recent diagnosis of HIV infection
  • Not yet started on anti-retroviral medications
  • Elevated viral load and reduced CD4 lymphocyte count (240)
  • Presents for evaluation and management of long-standing “tongue ulcers” with concern for herpes simplex virus or candidal infection

Initial evaluation

  • Thin appearing adult male
  • Bilateral tongue with thick, adherent white hyperkeratotic corrugated plaques without underlying erythema or edema
  • No evidence of oral candidiasis on exam – KOH preparation is negative
  • Topical tretinoin cream b.i.d. to affected areas
  • Referral to HIV primary care for evaluation and consideration of restart of anti-retroviral regimen
  • Follow-up in four weeks (moderately improved)