DIAGNOSTIC CHALLENGE OF AN ORAL ULCER IN A PATIENT WITH SYSTEMIC ERYTHEMATOSUS LUPUS

A white 47-year-old woman complained about a lesion in gingiva present for 2 months. Her medical history included systemic erythematosus lupus with previous use of corticosteroids. The intraoral examination revealed an irregularly shaped gingival ulcer in the upper posterior region. Radiographic examination showed no significant abnormalities. According to clinical and radiographic features, malignant or infectious lesions were hypothesized. After an incisional biopsy, microscopic evaluation revealed an intense mixed inflammatory infiltrate with the presence of Reed-Sternberg–like cells of Hodgkin lymphoma. Immunohistochemistry was positive for CD20, CD30, CD15, PAX-5, and LMP-1. Based on the clinical, microscopic, and immunophenotypic appearance, a diagnosis of Epstein-Barr virus (EBV)-positive mucocutaneous ulcer (EBVMCU) was established. After 2 months, total regression of the lesion was noted without any intervention. EBVMCU is a lymphoproliferative disorder presenting as isolated cutaneous or mucosal ulcers during treatment with immunosuppressive drugs or in elderly patients and frequently mimics a malignant neoplasm on the microscopic evaluation.