All of the following are recognised oral manifestations of AIDS EXCEPT:

Correct answer: B. Erythema multiforme

• A. KAPOSI SARCOMA is an AIDS-DEFINING malignancy caused by HHV-8, presenting as red-purple macules, plaques or nodules most commonly on the HARD PALATE and gingiva.
• B. CORRECT — this is the exception. ERYTHEMA MULTIFORME is an immune-mediated mucocutaneous hypersensitivity reaction, most often triggered by HERPES SIMPLEX infection or by drugs (sulfonamides, anticonvulsants, NSAIDs). It presents with target lesions on the skin and haemorrhagic, crusted lips with widespread oral ulceration. It occurs in immunocompetent people and is not part of the recognised list of HIV-associated oral lesions.
• C. ORAL HAIRY LEUKOPLAKIA is a non-removable, corrugated white lesion on the LATERAL BORDERS OF THE TONGUE caused by EPSTEIN-BARR VIRUS. It is strongly associated with HIV and correlates with declining CD4 count and disease progression.
• D. PSEUDOMEMBRANOUS CANDIDIASIS is the most common oral manifestation of HIV — removable white plaques leaving an erythematous base. Its appearance in a patient with no other cause (no dentures, no inhaled steroid, no antibiotic course) should prompt consideration of HIV testing.

Note: The standard EC-Clearinghouse grouping: strongly associated — candidiasis, hairy leukoplakia, Kaposi sarcoma, non-Hodgkin lymphoma, linear gingival erythema, necrotising ulcerative periodontitis. Less commonly associated — atypical ulceration, salivary gland disease with xerostomia, thrombocytopenic purpura, mycobacterial and viral infections.