Oral Hairy Leukoplakia

A 38-year-old man with a history of kidney transplantation presented with a 2-week history of burning, hairy lesions on his tongue. He was immunosuppressed with tacrolimus and mycophenolate mofetil. Examination revealed elongated, discolored papillae that were tender and non-removable by scraping. Fungal cultures were negative. Histopathology showed vacuolated keratinocytes, keratohyalin granules, parakeratosis, and hyperkeratosis with dermal inflammation. PCR testing of a tongue swab was positive for Epstein–Barr virus (EBV), confirming oral hairy leukoplakia, a benign manifestation of EBV reactivation in immunocompromised patients. Supportive care was initiated, including oral valacyclovir, smoking cessation counseling, and oral disinfectants. Lesions resolved within two weeks.

A 38-year-old man with a history of kidney transplantation presented with a 2-week history of burning, hairy lesions on his tongue. He was immunosuppressed with tacrolimus and mycophenolate mofetil. Examination revealed elongated, discolored papillae that were tender and non-removable by scraping. Fungal cultures were negative. Histopathology showed vacuolated keratinocytes, keratohyalin granules, parakeratosis, and hyperkeratosis with dermal inflammation. PCR testing of a tongue swab was positive for Epstein–Barr virus (EBV), confirming oral hairy leukoplakia, a benign manifestation of EBV reactivation in immunocompromised patients. Supportive care was initiated, including oral valacyclovir, smoking cessation counseling, and oral disinfectants. Lesions resolved within two weeks.