Oral Eosinophilic Ulcer, an Epstein-Barr Virus-Associated CD30+ Lymphoproliferation?

Abstract

Eosinophilic ulcer of the oral mucosa is a benign lesion of unclear pathogenesis mostly affecting the tongue. It has been suggested to represent a reactive pattern to several stimuli. We report on a 12-year-old boy who presented with a painless infiltrating ulcer on the gingiva of the lower jaw, which was covered by necrotic yellowish slough. There were no pathologic features of the jawbones or regional lymph nodes. Histopathological, immunohistochemical and gene rearrangement studies were in agreement with eosinophilic ulcer with predominant oligoclonal CD3+ and CD30+ T lymphocytes expressing the Epstein-Barr virus membrane protein. The ulcer resolved within 4 weeks and follow-up for 3 years revealed no evidence of recurrence. Epstein-Barr virus may have played a role in triggering this reactive lymphoproliferative disorder.

ALK negative anaplastic large cell lymphoma of the oral cavity showing spontaneous regression

“…None of these patients reported a previous history of cutaneous T-cell lymphoma, although one case developed a cutaneous lesion one year after the first oral ulcer [31][32][33] , and none of these patients developed any systemic manifestations of the oral disease. A similar case was reported that showed EBV positivity in a traumatic eosinophilic granuloma-like lesion with CD30 and CD3 expression [34] . This patient also showed no cutaneous or systemic manifestations.…”

Periodontal herpesviruses: prevalence, pathogenicity, systemic risk

“…Cytomegalovirus can replicate in gingival tissue and has been related to severe gingival pathosis affecting the underlying bone , to gingivitis and deep oral mucosal ulcerations in liver and kidney transplant receipients treated with immunosuppressive drugs , and to various types of gingival overgrowth . Epstein–Barr virus was identified in gingival ulcers associated with the dermatological disease, hydroa vacciniforme, in an 8‐year‐old boy ; in gingival ulcers related to the reactive lymphoproliferative disorder termed eosinophilic ulcer in a 12‐year‐old boy ; in lymphoproliferative gingival ulcerated lesions after renal transplantation in a 19‐year‐old girl ; and in gingival ulcers and tumorous lesions of individuals ≥ 70 years of age with lymphoproliferative disorders. Herpes simplex virus type 1 is the cause of acute herpetic gingivostomatitis in children and occasionally in adults , and was isolated from acute gingivostomatitis in a 3‐year‐old boy with the Gianotti–Crosti syndrome, a papular acrodermatitis .…”

TUGSE-a curious case series unveiled

“…Underlying medical conditions such as Lesch-Nyhan syndrome or familial dysautonomia may present initially as such ulcers. The duration of TUGSE varies, ranging from multiple weeks to months and sometimes up to a year.Delayed healing of TUGSE lesions has been reported to be associated with the lack of secretion of transforming growth factor TGF-a and TGF-b by eosinophils infiltrating the lesions [4]. The clinical differential diagnosis includes squamous-cell carcinoma, syphilis, tuberculosis, necrotizing sialometaplasia, deep fungal infections, histiocytosis X and lymphoma.…”