Differential Diagnosis

• Single most likely diagnosis
  • Oral candidiasis: This condition is characterized by white filamentous formations on the oral mucosa, which matches the description provided. It is a common opportunistic infection in individuals with HIV, especially when their immune system is compromised.
• Other Likely diagnoses
  • Hairy leukoplakia of the tongue: This condition, also known as oral hairy leukoplakia, presents with white patches on the tongue and is associated with Epstein-Barr virus infection, often seen in immunocompromised patients, including those with HIV.
  • Aphthous stomatitis: Although it typically presents with painful ulcers rather than white filamentous formations, aphthous stomatitis can occur in HIV-positive individuals and might be considered if the clinical presentation slightly varies or if there are additional symptoms not mentioned.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Kaposi's sarcoma: This is a type of cancer that can affect the oral mucosa, among other sites, and is more common in individuals with HIV/AIDS. Although it typically presents with purple lesions, early or atypical presentations could potentially mimic other oral pathologies.
  • Squamous cell carcinoma: Although less common in a 30-year-old, the immunocompromised state of an HIV-positive individual increases the risk of various cancers, including squamous cell carcinoma of the oral cavity. Early detection is crucial for treatment outcomes.
• Rare diagnoses
  • Other rare conditions such as histoplasmosis or cryptococcosis involving the oral mucosa could be considered, especially in an immunocompromised patient, but these would be less likely given the specific description of white filamentous formations.