Oral "hairy" leucoplakia in an African AIDS patient

Despite differences in the modes of transmission of human immunodeficiency virus (HIV) in Africa as compared to US and Europe the immunologic abnormalities and clinical profile in acquired immunodeficiency syndrome (AIDS) appear to be similar. Further evidence for this observation is provided by the case of a 34-year-old African male from Burundi who developed a form of oral leukoplakia previously unseen in African AIDS patients but resembling the so-called hairy leukoplakia found in homosexuals in California. In this African patient the diagnosis of AIDS was established on the basis of severe opportunistic infection (meningeal cryptococcosis) together with hepatic and pulmonary tuberculosis a severely decreased T-helper to suppressor cell ratio and the presence of antibodies to HIV. Dermatological examination revealed several mucocutaneous lesions including 1) candidiasis with patchy depapillation of the dorsum of the tongue and 2) discrete chronic lesions on the lateral sides of the tongue appearing as dense white mucosal patches about 1 cm in size. A sample of a persistent white lesion on the lateral border of this patients tongue was submitted to light and electron microscopic examination and immunoassay. The epithelium of the lingual mucosa presented parakeratotic cells acanthosis and surface projections typical of "hairy" leukoplakia. The prickle cells contained pyknotic nuclei and perinuclear halos. Herpes-like virus particles were observed within the nuclei of this prickle cells and in intercellular spaces. There was no evidence of papillomavirus particles. In immunoassay the virus particles did not react to antibodies against human herpes virus. The role of herpes virus and papillomavirus in the pathogenesis of "hairy" leukoplakia has yet to be established.