Necrotizing ulcerative stomatitis in human immunodeficiency virus-seropositive individuals: a review of the histopathologic, immunohistochemical, and virologic characteristics of 18 cases.
OBJECTIVE
The purpose of this retrospective study was to delineate the histopathologic, immunohistochemical, and virologic characteristics of 18 cases of necrotizing ulcerative stomatitis.


METHODS
Eighteen examples or oral ulcerations in human immunodeficiency virus-seropositive individuals were identified that displayed unique histopathologic features. Immunohistochemic staining for CD1a, CD3, CD23, CD68, HLA-DR, p24, cytomegalovirus, HSV-1, and HSV-2 was performed, along with in situ hybridization for Epstein-Barr virus RNA and special staining for bacteria and fungi.


RESULTS
The lesions demonstrated ulceration, extensive necrosis, leukocytoclasia, histiocytic vasculitis with luminal fibrin clots, and a prominent infiltrate of large atypical cells with amphophilic cytoplasm, vesicular nuclei, and prominent nucleoli, interspersed with crescentic histiocytes, a histologic picture resembling extranodal Kikuchi's disease. Immunohistochemical findings suggested that the large atypical cells were histiocytes. Fifty-six percent (10/18) of the cases were immunoreactive for human immunodeficiency virus p24 within focal histiocytes, whereas Epstein-Barr virus RNA was identified in 1 (6%) of 17 cases.


CONCLUSIONS
Necrotizing ulcerative stomatitis is an inflammatory disease characterized by specific, reproducible microscopic features. We postulate that the histopathologic resemblance of necrotizing ulcerative stomatitis to extranodal Kikuchi's disease reflects a similar immune response to differing pathogens.
Jones
A C
AC
Department of Pathology, The University of Texas Health Science Center at San Antonio, USA. jonesac@uthscsa.edu
Gulley
M L
ML
Freedman
P D
PD
D017088:AIDS-Related Opportunistic Infections / Q000473:pathology* / Q000821:virology; D000328:Adult; D000368:Aged; D001402:B-Lymphocytes / Q000473:pathology; D003587:Cytomegalovirus / Q000302:isolation & purification; D003713:Dendritic Cells / Q000473:pathology; D005260:Female; D005892:Gingivitis, Necrotizing Ulcerative / Q000473:pathology* / Q000821:virology; D016655:HIV Core Protein p24 / Q000032:analysis; D006679:HIV Seropositivity / Q000473:pathology*; D006684:HLA-DR Antigens / Q000032:analysis; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification; D006644:Histiocytes / Q000473:pathology; D006801:Humans; D007801:Langerhans Cells / Q000473:pathology; D007960:Leukocyte Disorders / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019226:Oral Ulcer / Q000473:pathology / Q000821:virology; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000473:pathology; D013927:Thrombosis / Q000473:pathology; D014657:Vasculitis / Q000473:pathology
D016655:HIV Core Protein p24; D006684:HLA-DR Antigens; D012367:RNA, Viral