Clinico-Pathologic Conference: Case 3

A 52-year old, HIV+ homosexual male presented to a dental specialist’s office with a 3 week history of painful “gum sores” and a white lesion of the right lateral tongue, which appeared 2 weeks after a vacation to the southern United States. General physical exam was unremarkable with vital signs as follows: temperature, 37.1°C; blood pressure, 116/74 mm Hg; pulse rate, 88 beats/min; and respiratory rate, 12 breaths/min. Appropriate medical care, including highly active antiretroviral therapy, had been administered since his diagnosis with HIV 10 years previously. His current regimen included abacavir/lamivudine, ritonavir and atazanavir. During this period, annual rapid plasma reagin (RPR) titers were non-reactive, including the latest testing 8 months prior to lesion onset. The patient indicated that he had been diagnosed and treated for syphilis in 1975, 33 years previously. Recent laboratory reports indicated an undetectable viral load with a CD4 count of 624 cells/mm³. …