Differential Diagnosis for Tongue Lesion with EBV and Non-Specific Staining

• Single Most Likely Diagnosis
  • Infectious mononucleosis (IM) or a related condition: This is likely due to the presence of EBV in the pathology report, which is a common cause of infectious mononucleosis. The reactive changes and ulceration are consistent with the clinical presentation of IM, which can cause oral ulcers and lesions.
• Other Likely Diagnoses
  • Acute herpetic gingivostomatitis or herpangina: These conditions can cause oral ulcers and are often associated with viral infections, including EBV. However, the presence of EBV specifically points more towards IM or a related condition.
  • Aphthous ulcers: Although these are common and can have a similar appearance, the presence of EBV and the specific pathology findings make this less likely.
• Do Not Miss Diagnoses
  • Lymphoma: Although the pathology report mentions no malignancy or dysplasia, EBV is associated with certain types of lymphoma, such as Burkitt lymphoma or nasopharyngeal carcinoma. It's crucial to ensure that no lymphomatous changes are overlooked, especially in immunocompromised patients.
  • Autoimmune disorders (e.g., pemphigus, lupus): These conditions can cause oral ulcers and might have non-specific staining patterns. They are less likely given the EBV findings but should be considered, especially if the patient has a relevant clinical history.
• Rare Diagnoses
  • EBV-associated hemophagocytic lymphohistiocytosis (HLH): This is a rare but potentially life-threatening condition that can be triggered by EBV infection. It's characterized by a systemic inflammatory response and would require a high index of suspicion and further diagnostic workup.
  • Other EBV-associated conditions (e.g., chronic active EBV infection): These are rare and would typically present with more systemic symptoms, but could be considered if the patient's clinical presentation and laboratory findings are consistent with such a diagnosis.