oprm-web-case-op-st-11

Patient: Adult male.

Chief Complaint:
The patient is concerned about mucosal lesions of the palate and gingiva covering the mandibular third molars. The palatal lesion is nonpainful. The patient has been aware of it for three weeks, during which time it has increased in size. It has not been treated. The gingival lesions cover the mandibular third molars. Purple patches are present on the skin of the temples bilaterally.

Medical History:
The patient reports hypotension. He states that he was hospitalized for hepatitis-B six years ago. He reports purple skin lesions on the temples and anterior neck of two weeks duration.

Dental History:
The patient seeks routine dental treatment every two to three years. He had a dental evaluation of the gingival swelling covering the mandibular third molars approximately two months ago.

Clinical Findings:
A 3 x 2 cm, purple, surface lesion is present on the hard palate. Purple surface lesions are present around the mandibular third molars, on the temples bilaterally, and on the neck. The skin lesions and the oral mucosal lesions are thickened but flat. All the thickened lesions are compressible, nontender, fixed to surface mucosa and underlying structures, and blanch upon pressure. Ecchymotic areas present at the junction of the hard and soft palate are not thickened. Anterior and posterior cervical lymph nodes and posterior auricular lymph nodes are enlarged, firm, and nontender. The posterior auricular nodes are fixed to surrounding structures.

There are no radiographs available for this case.

There are no lab reports available for this case.

There are no charts available for this case.

Summary:
This is a pigmented, localized, intravascular surface lesion:
  ~Pigmented – it is a localized blue-purple lesion
  ~Intravascular lesion – blanches upon pressure

Lesions to Exclude from the Differential Diagnosis:
Hemangioma
  ~Has not been present since birth or early childhood
Varix
  ~Typically not this large

Lesions to Include in the Differential Diagnosis:
Kaposi’s Sarcoma
  ~Presence of multiple vascular lesions
  ~Lymphadenopathy is present

Management:
The presence of multiple vascular lesions consistent with Kaposi’s sarcoma in a patient with persistent lymphadenopathy is suggestive of HIV/AIDS or other immunocompromised state.  Explain to the patient the cause and nature of the lesion and that it is almost always seen in immunosuppressed individuals.  Explain that if the patient has HIV, these lesions indicate that the disease has progressed to AIDS.  If there is any chance the patient has HIV, urge them to consider safe sex and contacting all sexual partners who they may have infected so they can check their own HIV status and practice safe sex.  Refer the patient to a physician.

Final Diagnosis:
Kaposi's Sarcoma