Hairy Leukoplakia


Vertical corrugated white streaks on the sides of the tongue, a result of latent Epstein-Barr virus, and always pathognomonic for late HIV infection (pre-AIDS or AIDS).  These pictures show extensive manifestations, but try to imagine a patient with only a fraction of what’s shown here.  Ever since diagnosing husband and child based on the wife/mother’s index finding of hairy leukoplakia, I routinely add to my oral exam, “Open your mouth, stick out your tongue, say ‘ah,’ point your tongue to the left, to the right, lift it up.”

One HIV patient had what appeared to be extensive hairy leukoplakia, but his CD4 lymphocyte count was 900 — way too high for the condition.  Then he explained he’d just quit smoking, & was chewing his tongue from the withdrawal anxiety.  Occlusal trauma from sharp molars is a perfect imitator.  I may have a patient stick their tongue in and out a few times while I squint to see where a wayward tooth-edge might contact.  If suspicious, I recommend an HIV test “just to be sure you’re negative.”