A 31-year-old HIV-positive man (CD4 count 320 cells/μL) has painless grey-white corrugated plaques on the lateral border of the tongue that cannot be scraped off. Biopsy shows koilocytic hyperplasia with ballooning of keratinocytes. This finding is most strongly associated with:

• A Epstein-Barr virus replication in lingual epithelium ✓
• B Candidal invasion of the stratum corneum
• C Human herpesvirus 8 induced vascular proliferation
• D Treponema pallidum induced gummatous ulceration

Explanation

Oral hairy leukoplakia results from active Epstein-Barr virus replication in lingual squamous epithelium and is seen mainly in untreated HIV infection, though CD4 can still be moderate. The corrugated non-scrapable lateral tongue plaque with epithelial ballooning is diagnostic. Candidiasis forms scrapable white patches, HHV-8 produces vascular Kaposi lesions, and syphilitic gummas are destructive ulcers, none matching this morphology or biopsy.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.