32. Painless genital and oral lesions

A 58-year-old MSM (man who has sex with men) HIV +ve patient presented with asyptomatic lesions on his tongue over one week. Clinical intra-oral examination revealed only two superficial ulcerations covered with whitish pseudomembrane and located in the dorsum (Figure 1) and in the ventral surface of his tongue. These ulcers had an erythematous base and smooth regular margins with normal surrounding tissues and were soft and painless in palpation. Extra-oral examination revealed systemic lymphadenopathy, mainly in the neck and groin area where multiple erythematous plaques with erosions on the scrotum were found (Figure 2). Fever, malaise or other general symptoms were not recorded.

This man was a chronic smoker but rarely a drinker and took only antihypertensive drugs. He was under a close follow-up for his HIV infection but without drugs. He had undergone investigations which showed a negative pathergy test, negative desmoglein antibodies 1 and 3 but positive FTA antibodies.