CAUSE OF ORAL ULCERS IN HIV-INFECTED PATIENTS - A STUDY OF 19 CASES

Objectives. To study the cause and clinical aspects of oral ulcers in HIV-infected patients. Study design. Forty-one consecutive HIV-positiv e patients with long-standing oral ulcers were examined; 19 were evalu ated by biopsy. From these 19 cases, viral, bacterial, and fungal cult ures and biopsies were taken in each patient. When indicated, special microbial stains were undertaken to identify bacteria or fungi. Ten ca ses without granulomatous bacterial fungal or lymphomatous features we re available for in situ hybridization to detect viral DNA of herpes s implex virus 1 and 2, cytomegalovirus, varicella-zoster virus, and Eps tein-Barr virus. Results. Most of the oral ulcers occurred in patients with severe immunodepression. Median CD4 T-lymphocyte count was 60 ce ll/mm(3) (range, 3 to 335). It was ascertained that nine (47%) patient s had nonspecific aphthous-like ulcers, and ulcers caused by herpes gr oup viruses were identified in six (31.5%) patients. One (5%) person w as diagnosed with non-Hodgkin's lymphoma; and in one (5%) patient, mul tiple ulcers were an expression of lues maligna. Two ulcers (10.5%) in the palate harbored mycotic granulomatous foci (cryptococcosis, histo plasmosis). In this population, almost all of these ulcers were found to be large, persistent, and painful. Conclusions. Nontumefactive oral ulcers in HIV-positive patients may be a source of diagnostic difficu lties because of the diverse array of underlying pathologic entities a nd multiplicity of etiologic agents. Biopsy should always be performed on long-standing ulcers because either infection or a neoplastic proc ess may be extant. in the absence of infection or neoplasm, such lesio ns are then designated as ulcers not otherwise specified.