OHL in HIV Diagnosis — ORE Part 1 MCQ

Correct answer: E — Oral hairy leukoplakia

The diagnosis is Oral Hairy Leukoplakia (OHL), caused by Epstein-Barr virus reactivation in immunosuppressed epithelium. The clinical presentation is pathognomonic: white corrugated patches on the lateral tongue border that cannot be scraped away (a key feature distinguishing OHL from removable lesions like oral thrush or frictional keratosis). OHL is strongly associated with HIV infection and occurs during immunosuppression, though here the patient has suppressed viral load—OHL may persist or emerge due to residual immune deficiency or reactivation during past lower CD4+ counts. Option C (lichen planus) typically presents with painful reticular or erosive patterns, not characteristic corrugation. Option B (leukoplakia) is a general diagnostic category lacking OHL's specific location and morphology. Option D (papilloma) is pedunculated and flesh-coloured, not corrugated white. Option A (frictional keratosis) is a smooth keratotic lesion usually on attached gingiva, rarely on lateral tongue, and typically causally linked to trauma.

Reference: NHS, Leukoplakia guidance: https://www.nhs.uk/conditions/leukoplakia/; supplemented by Greenspan et al., Clinical and histologic spectrum of oral hairy leukoplakia, Oral Surg Oral Med Oral Pathol 1992, and Pindborg JJ et al., Epstein-Barr virus latent and replicative gene expression in oral hairy leukoplakia, J Oral Pathol Med 1991.