Epstein-Barr virus associated mucocutaneous ulcer of the gingiva

Epstein-Barr virus associated mucocutaneous ulcer is a lymphoproliferative disorder of B cells in the oral cavity, oropharynx, skin and gastrointestinal tract, usually occurring in immunosuppressed patients. A 54-year-old female presented with a 5-week history of an ulcer which was present on the anterior gingival surface of her lower incisors. The patient subsequently developed an enlarged node in the ipsilateral neck. An array of investigations including histopathological analysis and an ultrasound guided fine-needle aspiration led to a final diagnosis of an Epstein-Barr virus associated mucocutaneous ulcer.These cases are rare and can present with significant diagnostic and therapeutic challenges to the clinicians due to their rarity, and similarity with other lesions including malignancy. We discuss our case and the relevant literature, with a focus on the challenging decision-making and multidisciplinary input to reach a satisfactory outcome for the patient.