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Oral hairy leukoplakia in healthy immunocompetent patients: a small case series

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Abstract

Background

Oral hairy leukoplakia (OHL) is caused by the Epstein-Barr virus (EBV) and usually presents in patients with human immunodeficiency virus (HIV) infection and systemic immunosuppression. It is rarely seen in patients who are immunocompetent. It is clinically characterised as an asymptomatic, soft, white and corrugated lesion that cannot be scraped from the surface it adheres to.

Methods

Immunocompetent patients with OHL attending Bristol Dental Hospital within the last 6 months were identified. EBV infection was demonstrated using EBV in situ hybridization. Clinical features and medical history were determined by reviewing medical records.

Case report

Four cases of OHL in immunocompetent individuals were identified. All lesions were located on the lateral borders of the tongue.

Discussion

OHL should be considered as a differential diagnosis for white patches on the lateral borders of the tongue in apparently healthy immunocompetent patients, even when they do not have a typical corrugated appearance. OHL should no longer be regarded as pathognomonic for HIV infection or systemic immunosuppression.

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References

  1. Greeenspan D, Greenspan JS, Conant M et al (1984) Oral “hairy” leukoplakia in male homosexuals: evidence of association with both papillomavirus and a herpes-group virus. Lancet 324(8407):831–834

    Article  Google Scholar 

  2. Bravo IM, Correnti M, Escalona L et al (2006) Prevalence of oral lesions in HIV patients related to CD4 cell count and viral load in a Venezuelan population. Med Oral Patol Oral Cir Bucal 11(1):E33–E39

    PubMed  Google Scholar 

  3. Greenspan D, Greenspan JS, Souza Y et al (1989) Oral hairy leukoplakia in an HIV-negative renal transplant recipient. J Oral Pathol Med 18(1):32–34

    Article  PubMed  CAS  Google Scholar 

  4. Blomgren J, Bäck H (1996) Oral hairy leukoplakia in a patient with multiple myeloma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 82(4):408–410

    Article  PubMed  CAS  Google Scholar 

  5. Chambers AE, Conn B, Pemberton M et al (2015) Twenty-first-century oral hairy leukoplakia—a non–HIV-associated entity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 119(3):326–332

    Article  Google Scholar 

  6. Okano M, Thiele GM, Davis JR et al (1988) Epstein-Barr virus and human diseases: recent advances in diagnosis. Clin Microbial Rev. 1(3):300–312

    Article  CAS  Google Scholar 

  7. Braz-Silva PH, de Rezende NPM, Ortega KL et al (2008) Detection of the Epstein–Barr Virus (EBV) by in situ hybridization as definitive diagnosis of hairy leukoplakia. Head Neck Pathol 2(1):19–24

    Article  PubMed  PubMed Central  Google Scholar 

  8. Nokta M (2008) Oral manifestations associated with HIV infection. Curr HIV/AIDS Rep 5(1):5–12

    Article  PubMed  Google Scholar 

  9. Greenspan JS, Greenspan D, Webster-Cyriaque J (2016) Hairy leukoplakia; lessons learned: 30-plus years. Oral Dis 22:120

    Article  PubMed  Google Scholar 

  10. Epstein JB, Sherlock CH, Greenspan JS (1991) Hairy leukoplakia-like lesions following bone-marrow transplantation. AIDS 5(1):101–102

    Article  PubMed  CAS  Google Scholar 

  11. King GN, Healy CM, Glover MT et al (1994) Prevalence and risk factors associated with leukoplakia, hairy leukoplakia, erythematous candidiasis, and gingival hyperplasia in renal transplant recipients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 78(6):718–726

    Article  CAS  Google Scholar 

  12. Piperi E, Omlie J, Koutlas IG et al (2010) Oral hairy leukoplakia in HIV-negative patients: report of 10 cases. Int J Surg Pathol 18(3):177–183

    Article  PubMed  Google Scholar 

  13. Prasad JL, Bilodeau EA (2014) Oral hairy leukoplakia in patients without HIV: presentation of 2 new cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 118(5):e151–e160

    Article  Google Scholar 

  14. Stowe RP, Kozlova EV, Yetman DL et al (2007) Chronic herpesvirus reactivation occurs in aging. Exp Gerontol 42(6):563–570

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Ouyang Q, Wagner WM, Walter S et al (2003) An age-related increase in the number of CD8+ T cells carrying receptors for an immunodominant Epstein–Barr virus (EBV) epitope is counteracted by a decreased frequency of their antigen-specific responsiveness. Mech Ageing Dev 124(4):477–485

    Article  PubMed  CAS  Google Scholar 

  16. Glaser R, Strain EC, Tarr KL et al (1985) Changes in Epstein-Barr virus antibody titers associated with aging. Proc Soc Exp Biol Med 179(3):352–355

    Article  PubMed  CAS  Google Scholar 

  17. Vescovini R, Telera A, Fagnoni FF et al (2004) Different contribution of EBV and CMV infections in very long-term carriers to age-related alterations of CD8+ T cells. Exp Gerontol 39(8):1233–1243

    Article  PubMed  Google Scholar 

  18. Galvin S, Healy CM (2014) Oral hairy leukoplakia in healthy, immunocompetent individuals. Ir Med J 107(6):179–180

    PubMed  CAS  Google Scholar 

  19. Hall LD, Eminger LA, Hesterman KS et al (2015) Epstein–Barr virus: Dermatologic associations and implications: Part I. Mucocutaneous manifestations of Epstein–Barr virus and nonmalignant disorders.J. Am Acad 72(1):1–19

    Article  Google Scholar 

  20. Hislop AD, Taylor GS, Sauce D et al (2007) Cellular responses to viral infection in humans: lessons from Epstein-Barr virus. Annu Rev Immunol 25:587–617

    Article  PubMed  CAS  Google Scholar 

  21. Khammissa RA, Fourie J, Chandran R et al (2016) Epstein-Barr Virus and its association with oral hairy leukoplakia: a short review. Int J Dent 2016:4941783

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Triantos D, Porter SR, Scully C et al (1997) Oral hairy leukoplakia: clinicopathologic features, pathogenesis, diagnosis, and clinical significance. Clin Infect Dis 25(6):1392–1396

    Article  PubMed  CAS  Google Scholar 

  23. Daniels TE, Greenspan D, Greenspan JS et al (1987) Absence of Langerhans cells in oral hairy leukoplakia, an AIDS-associated lesion. J Investig Dermatol 89(2):178–182

    Article  PubMed  CAS  Google Scholar 

  24. Walling DM, Flaitz CM, Hosein FG et al (2004) Effect of Epstein-Barr virus replication on Langerhans cells in pathogenesis of oral hairy leukoplakia. J Infect Dis 189(9):1656–1663

    Article  PubMed  Google Scholar 

  25. Reichart PA, Langford A, Gelderblom HR et al (1989) Oral hairy leukoplakia: observations in 95 cases and review of the literature. J Oral Pathol Med 18(7):410–415

    Article  PubMed  CAS  Google Scholar 

  26. Gulley ML (2001) Molecular diagnosis of Epstein-Barr virus-related diseases. J Mol Diagn 3(1):1–10

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Oral Medicine, The University of Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY, England

    Daire Shanahan, Rachel Cowie, Helen Rogers & Konrad Staines

Authors
  1. Daire Shanahan
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  2. Rachel Cowie
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  3. Helen Rogers
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  4. Konrad Staines
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Corresponding author

Correspondence to Daire Shanahan.

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The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Written informed consent was obtained from the participants for publication of the case series.

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Shanahan, D., Cowie, R., Rogers, H. et al. Oral hairy leukoplakia in healthy immunocompetent patients: a small case series. Oral Maxillofac Surg 22, 335–339 (2018). https://doi.org/10.1007/s10006-018-0709-7

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  • DOI: https://doi.org/10.1007/s10006-018-0709-7

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