FREDERIC B.ASKINMDWILLIAM H.WESTRAMD
A 29-YEAR-OLD Asian man presented with a 2-month history of expanding, painless tongue and nasal lesions. His medical history was significant for chronic active hepatitis B. He was taking no medications and had no allergies. Physical examination revealed multiple raised, firm, nontender, white plaques on the dorsum and lateral aspect of the tongue, extending to the base of tongue (Figure 1). He also had crusting papules and pustules in both nasal vestibules. There was no cervical lymph adenopathy, and the results of the rest of the head and neck examination were unremarkable. Microscopic examination of the biopsy specimens from the tongue lesion showed a dense perivascular and interstitial plasma cell infiltrate, with extensive neovascularization and endothelial cell hyperplasia (Figure 2 [E indicates endothelium; N, neovascularization; and P, plasma cell infiltrate ]). A silver stain demonstrated numerous spirochetes (Figure 3). The diagnosis was confirmed by serologic evaluation.
Monhian N, Murr AH, Mandpe AH, Baehner FL. Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2001;127(2):217. doi:10.1001/archotol.127.2.217