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Aphthous Ulceration HIV — SCE Infectious Diseases MCQ

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ModerateHIV MedicineAphthous Ulceration HIVSCE Infectious Diseases

A 35-year-old man with HIV develops a new painful oral ulcer. He is on Co-trimoxazole prophylaxis (960 mg daily for PJP/Toxoplasma). The ulcer is shallow with an erythematous halo and no vesicles. HSV PCR from the ulcer is negative. Syphilis serology is negative. What is the most likely diagnosis?

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Correct answer: C — Aphthous ulceration — the most common cause of non-infectious oral ulceration in HIV; recurrent aphthous stomatitis is more frequent and severe in PLWH than the general population

Aphthous ulceration is extremely common in HIV (more frequent and severe than in the general population) and is the most common NON-INFECTIOUS cause of oral ulceration in PLWH. It presents as painful shallow ulcers with erythematous haloes — clinically identical to aphthous ulcers in immunocompetent patients but often larger and more persistent. After excluding infectious causes (HSV, syphilis, CMV) and malignancy (KS, lymphoma), treatment is topical corticosteroids (Triamcinolone orabase), topical analgesics (Benzydamine spray), or Thalidomide for severe/refractory cases.

Reference: BHIVA 2022 – Oral conditions in HIV; NICE CKS 2024 – Mouth ulcers