A surreal illustration of a tongue with oral hairy leukoplakia subtly transforming into leukemia cells, symbolizing early detection of a hidden condition.

Oral Hairy Leukoplakia: An Unexpected Early Warning Sign of Leukemia

Nico Varela in Health & Wellness August 2025 • 4 min read.

"Could a tongue patch be more than just a harmless anomaly? Learn how oral hairy leukoplakia can sometimes signal a serious underlying condition."

Oral hairy leukoplakia (OHL) is typically associated with the reactivation of the Epstein-Barr virus (EBV), manifesting as distinctive whitish patches, often corrugated or hairy in appearance, primarily on the sides of the tongue. While commonly linked to individuals with compromised immune systems, such as those with AIDS, OHL can also occur in other immunocompromised conditions.

In patients with leukemia, the occurrence of OHL is infrequent and typically arises following chemotherapy treatments. This article highlights a unique instance of OHL serving as the initial sign of acute myeloid leukemia (AML) in a previously healthy 15-year-old child, emphasizing the importance of recognizing such atypical presentations.

This article aims to raise awareness among both the public and healthcare professionals about the potential for OHL to indicate serious underlying conditions, even in the absence of typical risk factors. Early detection can significantly impact treatment outcomes and overall prognosis.

The Case: When a Tongue Patch Signaled Leukemia

A surreal illustration of a tongue with oral hairy leukoplakia subtly transforming into leukemia cells, symbolizing early detection of a hidden condition.

A 15-year-old boy, a soccer player with no prior medical issues, noticed a persistent whitish patch on the left side of his tongue. Initially asymptomatic, the lesion gradually increased in size, prompting medical evaluation. A physical examination revealed corrugated, firmly attached whitish patches that couldn't be easily scraped off.

Differential diagnoses considered at first included oral candidiasis, oral lichen planus, and oral hairy leukoplakia. A biopsy of the lesion revealed key characteristics:

Papillomatosis (wart-like growths)
Hyperkeratosis (thickening of the outer layer of skin)
Parakeratosis (abnormal keratinization)
Acanthosis (thickening of the prickle cell layer)
Ballooning degeneration in the stratum spinosum (a specific layer of the epidermis)

Further tests confirmed the presence of EBV in the lesion, while a routine blood test revealed a significantly low platelet count and the presence of blast cells. Subsequent bone marrow biopsy led to the diagnosis of acute myeloid leukemia (AML M2). Despite immediate chemotherapy, the patient's outcome was unfavorable due to chromosomal abnormalities, and he succumbed to septic shock after a three-month battle.

Why This Case Matters: Recognizing the Unexpected

While OHL is commonly associated with immunosuppression, this case underscores the rare possibility of it being an initial sign of acute myeloid leukemia. Recognizing such atypical presentations is crucial for early diagnosis and intervention.

This case emphasizes the importance of thorough medical evaluation when encountering unusual oral lesions, especially in individuals without apparent risk factors for immunosuppression. Though rare, considering the possibility of underlying systemic diseases like leukemia can significantly impact patient outcomes.

Although OHL is not generally considered a prognostic indicator except in AIDS, this instance suggests that, when associated with hematologic malignancies, it might indicate an advanced stage or poorer prognosis. This highlights the need for further research to understand the relationship between OHL and leukemia outcomes.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.5021/ad.2010.22.1.73, Alternate LINK

Title: Oral Hairy Leukoplakia Which Occurred As A Presenting Sign Of Acute Myeloid Leukemia In A Child

Subject: Dermatology

Journal: Annals of Dermatology

Publisher: Korean Dermatological Association and The Korean Society for Investigative Dermatology

Authors: Hyun-Ho Cho, Su-Han Kim, Sang-Hee Seo, Do-Sang Jung, Hyun-Chang Ko, Moon-Bum Kim, Kyung-Sool Kwon

Published: 2010-01-01

Everything You Need To Know

What is oral hairy leukoplakia (OHL)?

Oral hairy leukoplakia (OHL) is a condition that manifests as distinctive whitish patches, often with a corrugated or hairy appearance, typically found on the sides of the tongue. These patches are usually linked to the reactivation of the Epstein-Barr virus (EBV). In this specific instance, OHL served as an unexpected early sign of acute myeloid leukemia (AML). The article highlights a unique case where OHL appeared as the first indication of AML in a previously healthy 15-year-old.

Why is this particular case important?

The significance of this instance lies in its atypical presentation. Typically, OHL is associated with individuals who have compromised immune systems, like those with AIDS. However, its appearance as the initial sign of acute myeloid leukemia (AML) in a previously healthy child is rare and emphasizes the importance of recognizing unusual symptoms for early diagnosis. Early detection can drastically improve treatment outcomes and the overall prognosis.

What is the connection between acute myeloid leukemia (AML) and this case?

Acute myeloid leukemia (AML) is a type of cancer that affects the blood and bone marrow. In this case, the patient's diagnosis of AML was confirmed via a bone marrow biopsy, which identified the presence of blast cells and significantly low platelet counts. This diagnosis was made after the appearance of oral hairy leukoplakia (OHL) and following further tests, which indicated the presence of EBV in the lesion. Despite immediate chemotherapy, the patient's outcome was unfavorable due to chromosomal abnormalities.

What are the physical characteristics and diagnostic findings of oral hairy leukoplakia (OHL)?

The physical characteristics of oral hairy leukoplakia (OHL) include whitish patches that are firmly attached to the tongue and often have a corrugated appearance. A biopsy of the lesion can reveal several key features, including papillomatosis (wart-like growths), hyperkeratosis (thickening of the outer layer of skin), parakeratosis (abnormal keratinization), acanthosis (thickening of the prickle cell layer), and ballooning degeneration in the stratum spinosum (a specific layer of the epidermis). These characteristics, along with the presence of the Epstein-Barr virus (EBV), help to confirm the diagnosis of OHL.

Why is it important to be aware of the link between oral hairy leukoplakia (OHL) and acute myeloid leukemia (AML)?

This case is a reminder to healthcare professionals and the public about the importance of recognizing unusual symptoms. Early detection of conditions like acute myeloid leukemia (AML), which can be indicated by unusual signs such as oral hairy leukoplakia (OHL), can have a significant impact on treatment outcomes. Prompt medical evaluation and diagnosis can lead to timely intervention and potentially improve the patient's prognosis. Awareness of such atypical presentations is crucial for effective healthcare management.