Pathology · patient case question
The white plaques that wipe away leaving an erythematous base are:
Patient case: HIV, and a Platelet Count of 18,000
Patient: 42-year-old male
Chief Complaint: Sore mouth and a broken tooth requiring extraction.
Background: HIV positive for eleven years. Recently changed antiretroviral regimen. Brings recent laboratory results.
Medications: Antiretroviral therapy
Vital Signs: BP 122/76 mmHg · HR 78 bpm · RR 16 · T 98.6°F
Findings: Laboratory: CD4 410 cells/µL, viral load undetectable, haemoglobin 13.1 g/dL, PLATELETS 18,000/µL, INR 1.0. Intraorally, removable white plaques on the buccal mucosa and palate that leave an erythematous base when scraped.
Show answer and explanation
Correct answer: A. Pseudomembranous candidiasis
- A. CORRECT. PSEUDOMEMBRANOUS CANDIDIASIS (thrush) is the definitive answer and is the most common oral lesion in HIV. The diagnostic feature is exactly as described — the plaques are WIPEABLE and leave an erythematous, sometimes bleeding, base. The plaque is a mat of fungal hyphae, desquamated epithelium and debris.
- B. Oral hairy leukoplakia is EBV-driven, appears as vertical white corrugations on the LATERAL TONGUE, and does NOT wipe off. It is highly specific for HIV but is a different lesion.
- C. Leukoplakia is by definition a white patch that cannot be wiped away and cannot be attributed to any other condition. The wipeability excludes it.
- D. Lichen planus presents as fine white lace-like Wickham striae, usually bilateral on the buccal mucosa, and does not wipe off.
Note: Other HIV-associated oral lesions to recognise: linear gingival erythema, necrotizing ulcerative periodontitis, Kaposi sarcoma (HHV-8, purple macules on the palate), and aphthous-like major ulcers.