Presented by Dr. Rosamonde St. Pierre, Laval, PQ, Canada
The patient, a 14-year-old girl, who presented with a mildly painful
process on the lateral borders of the tongue for about 4 months. She is a
healthy child whose only medication is oral contraceptives for heavy menstrual
cycles. She has never used inhaled steroids or nose drops; but did have mononucleosis at 4 or 5
years old. There is no history of blood transfusions. The affected areas are sensitive when she
eats spicy or acidic foods.
OE: The examination shows rough, whitish papillae on the lateral margins of the tongue. KOH prep was negative for Candida
October 2020 (taken by patients mother:
January 2021 (taken at dermatologist office)
Diagnosis: Oral Hairy Leukoplakia (OHL) must be considered. Although
OHL was first described in association with HIV/AIDS, it has been reported in otherwise
was first described in 1984, and initially all OHL patients had HIV/AIDS. Over the years, it has been seen in people
with other immunedeficiencies and even in patients with normal immune
systems. This patient has no risk
factors for immune compromise or HIV/AIDS. The question Dr. St. Pierre asks is how aggressively
this 14 year-old should be worked up? Florid OHL is much more impressive in its appearance. This patient's lesions are subtle and appear to be resolving without treatment.
Oral Hairy Leukoplakia
Manu Rathee 1 , Prachi Jain 2
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.
2020 Apr 22. Free Full Text.
2. Darling MR et al. Oral Hairy Leukoplakia in
Patients With No Evidence of Immunosuppression: A Case Series and Review of the
Literature. J Can Dent Assoc 2018 May;84:i4.
Abstract: Objectives: Oral hairy leukoplakia (OHL) is caused by Epstein-Barr virus (EBV) and is often associated with HIV and other immunosuppressive conditions. It is rare in HIV-negative patients, but has been reported in patients who use immune-modulating medications (e.g., cyclosporine).
Study design: A series of 7 new cases of OHL among HIV-negative patients is described. Langerhans cells were counted using an immunoperoxidase stain for CD1a and light microscopy.
Results: The 7 patients were male, ranging in age from 26 to 69 years. Clinically, all lesions were diagnosed as leukoplakia on the lateral border of the tongue. Microscopic examination revealed hyperparakeratosis and candidiasis in some cases, acanthosis and a band-like zone with clearing of cells in the upper spinous layer, which were EBV-positive by in-situ hybridization. There was a significant decrease in Langerhans cell counts in OHL patients.
Conclusion: OHL can occur in HIV-negative patients.
3. Shanahan D et. al. Oral hairy leukoplakia in
healthy immunocompetent patients: a small case series. Oral Maxillofac Surg.
Conclusion: Physicians must have a high index of suspicion for OHL when considering a differential diagnosis for white patches on the lateral borders of the tongue in apparently healthy immunocompetent patients. OHL should no longer be solely attributed to HIV infection, or immunosuppression. Greater awareness of OHL may lead to further cases in immunocompetent people being reported, particularly as our population ages.
4. Kyle Burke Jones, Richard Jordan. White lesions in the oral cavity: clinical presentation, diagnosis, and treatment. Semin Cutan Med Surg. 2015 Dec;34(4):161-70
tongue; hairy tongue; leukoedema; nicotine stomatitis; oral frictional
hyperkeratosis; oral leukoplakia; oral lichen planus; oral lichenoid reaction;
oral squamous cell carcinoma; smokeless tobacco keratosis; white sponge nevus. (see comment # 7)