Oral Condyloma Acuminatum Posing as a Clinical Diagnosis in an AIDs Patient
Condyloma Acuminatum is a benign proliferation of epithelium, most commonly found on the genital, and perianal regions. Extra-genital lesions are less common, but may involve mucous membranes of oral cavity. Men, smokers, immunosuppressed and those involved in oral sexual practice with multiple partners over longer period of time, are at higher risk for developing oral HPV. Oral HPV infections in immunocompetent individuals usually do not transform into malignant lesions due to their ability to clear the infection within 12 months and develop immunity against possibility of acquiring HPV in future. The case is reported due to its relative rarity of occurrence in oral cavity in an AIDS patient. The authors also wanted to question the possibility of reactivation of an already latent HPV or acquiring new HPV in oral cavity in an AIDS patient.
A 47 year old male, with a HIV and AIDS diagnosed over twenty years ago, presented to the hospital from prison with worsening depression and poor appetite. The physical examination of the oral cavity of the patient revealed intraoral multiple fleshy flat topped growths, located on the dorsal surface of the tongue and on the palate. The lesions had firm consistency, whitish appearance on an erythematous base and ranged from single lesion to clusters on the mucosal surfaces. The intervening mucous membrane was normal. Complete physical examination revealed no other lesion. Patient refused to provide sexual history, but admitted to a 15 pack year smoking history. CD4 T cell count was 20 and CD4/CD8 ratio was 0.03. HIV-viral (RNA) load revealed 22 copies/ml. Syphilis profile and Hepatitis C Ab were negative. While the patient was recommended for a biopsy of the oral lesion, he deferred the work up for outpatient, and later failed to follow up.
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Poor personal hygiene, orogenital contact have been identified as potential modes of transmitting and acquiring Condyloma Acuminata. Patients with AIDS may have their oral cavity as the reservoir of HPV in subclinical state. Despite many studies the underlying mechanism has not been clearly understood, but the immunosuppressed state, has been thought of leading towards the promotion of acquiring new infection or reactivation of latent HPV infections. In our patient, The immunosuppression was most likely responsible for the development of oral Condyloma Acuminata.