Pathology · patient case question
What is the diagnosis?
Patient case: Asthmatic man with white plaques on the tongue and buccal mucosa
Patient: Male, 41 years old
Chief complaint: “I'm here for a check up and I want a cleaning done today.”
Background: Asthma. Medication: beclomethasone dipropionate (Qvar®) inhaler.
Current findings: White plaques on the buccal mucosa and dorsal surface of the tongue. The plaques wipe away, leaving erythematous mucosa underneath.
Show answer and explanation
Correct answer: D. Pseudomembranous candidiasis
- A. Leukoplakia is by definition a white patch that does not rub off and cannot be attributed to another cause.
- B. Oral hairy leukoplakia occurs on the LATERAL tongue in immunosuppression, is EBV-driven, and does not rub off.
- C. Lichen planus produces fine white striae (Wickham striae) that CANNOT be rubbed off, usually bilaterally on the buccal mucosa.
- D. CORRECT. A WIPEABLE white plaque leaving an erythematous base is the defining feature of PSEUDOMEMBRANOUS CANDIDIASIS (thrush). The inhaled corticosteroid provides the local immunosuppression that permits candidal overgrowth.
Note: The single discriminating question for any white lesion: does it wipe off? If yes, think candidiasis.