Oral medicine case book 73 : HIV associated oral ulcerations : differential diagnosis

06 Jun 2016

A 36 year old female suffering from multiple oral ulcers was referred to the Department of Periodontics and Oral Medicine clinic at the University of Pretoria in February 2016. The ulcers had been present for a month, were first seen as "small sores" that had subsequently increased in size. On examination, multiple, relatively painful, large (>1cm) ulcers were seen on the palate, labial mucosa, tongue and gingiva (Figure 1). She also had gingivitis and a plunging ranula of the submandibular gland and reported recent weight loss. The patient had been diagnosed with retroviral disease in 2010; her latest CD4 count was 49 with a viral load of 111 797 copies. Her haemoglobin (Hb) was 11. 7g/dL and the estimated glomerular filtration rate (eGFR) >60mL/min. She had defaulted antiretroviral treatment (ARV) for a year and was reinstated on treatment, on ARVs regimen 2 comprising of Lamzid and Alluvia in January 2016. Empiric Dapsone treatment had been instituted for the ulcers.