Ann Dermatol.  2010 Feb;22(1):73-76. 10.5021/ad.2010.22.1.73.

Oral Hairy Leukoplakia Which Occurred as a Presenting Sign of Acute Myeloid Leukemia in a Child

• Cho HH
• Kim SH
• Seo SH
• Jung DS
• Ko HC
• Kim MB
• Kwon KS

• KMID: 2172044
• DOI: http://doi.org/10.5021/ad.2010.22.1.73

Abstract

Oral hairy leukoplakia (OHL) is caused by the reactivation of a previous Epstein-Barr virus (EBV) infection in the epithelium of the tongue. Most lesions are characterized by corrugated whitish patches on the lateral border of the tongue. It is frequently associated with AIDS, but cases in patients with other immunosuppressed states have also been reported. In leukemia patients, OHL is rarely encountered, and appears only after chemotherapy. We report a case of OHL which occurred as a presenting sign of acute myeloid leukemia (AML) in a previously healthy 15-year-old child. A 15-year-old boy presented with a whitish patch on the left lateral border of the tongue. The biopsy specimen revealed papillomatosis, hyperkeratosis, acanthosis and ballooning degeneration in the stratum spinosum. The patient was EBV seropositive, and PCR analysis of EBV DNA in the lesional tissue was positive. After the diagnosis of OHL in dermatologic department, the patient was referred to pediatrics due to the abnormal peripheral blood smear, and was diagnosed with AML.

Keyword

Acute myeloid leukemia; Ebstein-Barr virus; Oral hairy leukoplakia

MeSH Terms

Adolescent
Biopsy
Child
DNA
Epithelium
Herpesvirus 4, Human
Humans
Leukemia
Leukemia, Myeloid, Acute
Leukoplakia, Hairy
Papilloma
Pediatrics
Polymerase Chain Reaction
Tongue
DNA

Figure

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  Fig. 1 Tightly adhered whitish patches are located unilaterally in the left border of the tongue showing slightly hairy projections.

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  Fig. 2 Hyperkeratosis, parakeratosis, acanthosis, ballooning degeneration in the stratum spinosum and vacuolated cells with small, round, deeply basophilic nuclei surrounded by a narrow clear halo are shown (H&E, ×100).

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  Fig. 3 Cytoplasmic halo surrounding the nucleus and peripheral margination of chromatin in the nucleus are shown (H&E, ×1,000).

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  Fig. 4 Positive result shows the EBV band 201 bp region of the EBV BamHI W repeat. M: marker, Lane 1: EBV positive control, Lane 2: patient negative control, Lane 3: negative control (D.W), Lane 4: patient sample 1 (100 ng/dl), Lane 5: patient sample 1 (50 ng/dl), Lane 6: patient sample 2 (100 ng/dl), Lane 7: patient sample 2 (50 ng/dl).

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