Epstein-Barr virus-positive mucocutaneous ulcer of the gingiva: A self-limiting disorder of the immune compromised that can present with aggressive clinico-radiological and histomorphological features

Abstract

Oral ulcerations of the gingiva or mucosa require differential diagnosis. One of these diagnoses may be Epstein-Barr virus (EBV)-positive mucocutaneous ulcer.Epstein-Barr virus (EBV)-positive mucocutaneous ulcer (EBVMCU) is a rare diagnosis and was first described in 2010. It is described as an Epstein-Barr virus (EBV)-mediated B-cell proliferation and occurs in patients with immunosuppression, e.g., therapy with azathioprine, methotrexate, or cyclosporine, but also in patients with age-related immune senescence or chronic diseases/infections such as diabetes and AIDS/HIV. In 2017, EBVMCU was recognized by WHO and included in the classification of tumors.Mucocutaneous ulcerations often present as indolent, sharply demarcated ulcerations of the gingiva. Over 70 % of these ulcerations occur in the oral and pharyngeal cavities. EBV is secreted in saliva and can develop EBVMCU in association with trauma, such as tooth extraction.We present three patient cases with EBVMCU. We describe the clinical presentation, differential diagnosis and diagnosis, treatment, and clinical outcome.

Keywords

• EBV
• Mucocutaneous ulceration
• Immune system
• Treatment