White End of Hairy Leukoplakia to the Dark End of Human Immunodeficiency Virus: A Diagnostic Challenge.

As commonly accepted hairy leukoplakia may be highly associated with human immunodeficiency virus (HIV) infection and may be the first sign of the infection. Even though it is highly associated with immunosuppression, the awareness of oral hairy leukoplakia became prevalent with the advent of HIV and AIDS and it became the first suspicious sign of HIV and later the hallmark of disease process. A 36-year-old male taxi driver presented with the complaint of deposits on his teeth. Medical history revealed chronic cough, weight loss, loss of appetite, recurrent episodes of fever since 1-year, which was not investigated. Examination revealed multiple palpable cervical lymph nodes with intraoral findings such as pigmentation on buccal mucosa, erythema of palate, non-scrapable and non-tender white patch on lateral border of tongue, papillary atrophy on the dorsal surface of the tongue, and gingival inflammation (Figures 1-3). Patient was referred to higher medical center for investigation where the patient was diagnosed as HIVpositive.