Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) is a rare entity, first described in 2010 by Dojcinov & al. It manifests itself as an ulcerated, painful, well-circumscribed lesion that can affect the oropharynx, oral mucosa, gastro-intestinal tract and skin of immunocompromised patients. This condition tends to regress spontaneously, with or without a reduction in the dosage of immunosuppressive treatment. However, this entity represents a real diagnostic challenge in view of its clinical and/or histopathological similarities with malignant pathologies such as squamous cell carcinoma or lymphoma. We report the case of a 75-year-old, kidney transplanted patient, referred to the maxillofacial surgery and stomatology department of Orléans University Hospital for a suspicious, heterogenous, lesion localized to the mandibular anterior edentulous ridge. Clinical and radiographic examination revealed a 4 cm, ulcerative-bourgeoning lesion involving the anterior mandibular mucosa, the labial mucosa, the mandibular cortical bone and the floor of the mouth. The results of the clinical, radiological and immunohistochemical examinations carried out, led to the establishment of two main diagnostic hypotheses: polymorphic Epstein-Barr virus-positive (EBV+) B lymphoproliferation in the context of immunosuppression or EBVMCU. Following a multidisciplinary team meeting, immunosuppressive treatment were suspended, leading to a complete healing of the lesion, confirming the diagnosis of EBVMCU. This case illustrates the particular attention that must be paid to this type of lesion in poly-comorbid and immunocompromised patients, so as not to over-treat patients already weakened by multiple surgical interventions and drug therapies.
Rohard et al. (Wed,) studied this question.