Main complaint and medical history:

A 24 year old female patient presented at the Oral Med Clinic complaining of ‘things’ growing in her mouth since 2007. She noticed that as time went by, more and more began appearing. The lesions are asymptomatic but the patient is worried about the constant new lesions appearing.

The patient is HIV positive, diagnosed in 2010 and has been on HAART therapy since August 2014. She reports no allergies or other comorbidities. Previous treatment of the lesions affecting the lips and vaginal mucosa was Silver Nitrate application that did not provide satisfactory results. Her last absolute CD4 count was recorded at 320 cells/uL.

Clinical examination:

Extra-oral findings included:

  • Hyperpigmentation of fingers. A history of finger nail biting was reported
  • Small hyperpigmented nodule on right hand. Well circumscribed about 1cm
  • Patient reported the presence of lesions on her lower extremities and vagina , which she has sought treatment for, none of which have been successful .

Intra- oral findings included:

  • Multiple generalized verrucous papillary plaques, nodules and papillomas present, affecting the buccal mucosa, labial mucosa, palate, tongue, gingiva and interdental papilla.
  • Alveolar mucosa and attached gingiva also affected
  • Mixed variety of sessile and pedunculated nodules, some pink and some hyperkeratotic. Coalescing nodules noted on the attached gingiva and tongue
  • Lesions along occlusal line display traumatic hyperkeratosis

Figure 1 Multiple generalized verrucous papillary nodules present in the patient’s mouth



Excisional biopsy of the lesions on left buccal mucosa. Sutures placed and post op instructions given. Histopathology confirmed the clinical diagnosis of multifocal epithelial hyperplasia.

Due to the presence of plaque and calculus, initial phase periodontal therapy was instituted and a schedule formulated to excise the lesions. Patient then returned for further electrosurgical excisions with two visits remaining.


Figure 2: immediately following electrosurgical excision under local anaesthesia