Gs. Liang et al., AN EVALUATION OF ORAL ULCERS IN PATIENTS WITH AIDS AND AIDS-RELATED COMPLEX, Journal of the American Academy of Dermatology, 29(4), 1993, pp. 563-568
Background: Patients with HIV infection can have recurrent and persist
ent oral ulcers, not attributable to known infectious agents. Objectiv
e. Our aim was to evaluate prospectively oral ulcers in patients with
HIV infection to determine whether an etiologic agent could be identif
ied. Methods: Sixteen patients with HIV infection who had oral ulcers
not attributable to known causes had culture of the base and a biopsy
specimen taken from the ulcer. Cultures were obtained for herpes simpl
ex and varicella-zoster viruses, mycobacteria, and fungi. By polymeras
e chain reaction (PCR) analysis with primer/probe sets for herpes simp
lex viruses 1 and 2, varicella-zoster virus, cytomegalovirus, human pa
pillomavirus, and Mycobacterium tuberculosis, each biopsy specimen was
analyzed for the presence of DNA from these organisms. Specimens were
also evaluated histologically. Results: Histoplasmosis was detected h
istologically in one biopsy specimen, candidiasis in a second, and her
petic changes in a third. Viral cultures were positive for herpes simp
lex virus 1 in four cases and herpes simplex virus 2 in one case. PCR
analysis detected DNA for herpes simplex virus 1 in one case and herpe
s simplex virus 2 in another; DNA from other pathogens was not identif
ied. In the remaining eight patients, hematoxylin-and-eosin staining r
evealed eosinophilic ulcers in five cases and nonspecific changes in t
hree cases. Conclusion: The etiologic agent of recurrent or persistent
oral ulcers in patients with AIDS and AIDS-related complex was not id
entified in 50% of patients. PCR analysis was not useful. Herpes simpl
ex virus or other pathogens were not detected in ulcers containing num
erous eosinophils.