Case history
Case history #1
A 28-year-old man presents with pain on swallowing. He has no oral symptoms, but clinically has abundant, creamy white, loosely adherent plaques throughout his mouth. Lesions are especially prominent in his buccal, palatal, and pharyngeal mucosa. HIV infection was diagnosed 2 years ago, but he has not yet started anti-retroviral treatment. His last CD4 count and viral load measurement was 8 months ago.
Case history #2
A 64-year-old man presents with a complaint of burning under his maxillary denture. He has hypertension and osteoarthritis. His medications include a thiazide diuretic, a non-selective beta-blocker, and a non-prescription analgesic. Intra-orally, he has severely erythematous palatal mucosa, with a distinct granular appearance. His mucosa is dry and his salivary flow is minimal.
Other presentations
Among other less common variants of oral candidiasis are median rhomboid glossitis (also known as central papillary atrophy), hyperplastic candidiasis (also known as candidal leukoplakia), and linear gingival erythema (LGE).
Median rhomboid glossitis is a form of candidiasis seen as an asymptomatic erythematous area with a rhomboid outline on the central dorsal aspect of the tongue.[1] This lesion is usually symmetrical and the surface may be smooth or lobulated.[1]
Hyperplastic candidiasis is the least common form of oral candidiasis and is considered somewhat controversial.[1] Some believe that it is caused by Candida superimposing onto existing keratotic lesions; however, others believe that Candida are capable of inducing a hyperkeratotic lesion alone.[1] It may appear as a white patch that cannot be rubbed off; in this case the term chronic hyperplastic candidiasis is appropriate.[1] If appearing with mixed red and white areas (speckled), it may have dysplastic potential.[1]
Other reported associations include immune disorders (mucocutaneous candidiasis) and endocrine abnormalities involving hypothyroidism, hypoparathyroidism, hypoadrenalism, or diabetes mellitus.[1] LGE is a specific HIV-related periodontal manifestation that presents as a continuous or patchy band of erythema involving the free gingival margin.[2][3][4] LGE lesions are persistent, despite removal of plaque and improvement of home oral care. LGE is related to the invasion of the gingival tissues by Candida albicans and the advancement of periodontal tissue breakdown that also correlates with advancing HIV disease.[5]
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