Abstract

Introduction: Focal epithelial hyperplasia (FEH), also known as Heck disease, is a rare, benign human papillomavirus (HPV)-induced epithelial proliferation of oral mucosa. It is clinically characterized by multiple asymptomatic exophytic, skin-colored papules and nodules. Histologically by acanthosis and “mitosoid figures” associated with HPV 13 and 32.

Case discussion: A 30-year-old healthy Haitian male presented for evaluation of dyspigmentation and rough papules involving the oral mucosa. No similar family history was present. Physical examination revealed multiple soft, light pink to hypopigmented verrucous papules on the lower and upper lips, gingiva and buccal mucosa. An HIV test was negative. Shave biopsies demonstrated acanthosis, koilocytes, and karyorrhectic cells (“mitosoid figures”). Special stains revealed wild-type P53 and negative low-risk (HPV -6 and -11) and high-risk HPV subtypes by in situ hybridization (ISH). However, we demonstrated positivity for HPV L1 capsid protein using a BIOCARE Ab that detects HPV without specifying genotyping. HPV DNA ISH with a red fluorescent-based signal targeting HPV 13 and 32 strongly signaled HPV 13. The patient was treated with cryotherapy.

Conclusion: FEH is frequently seen in HIV patients and is common in Sub-Saharan Africa and Central America. Cases of FEH of Caribbean descent are rare, with only five other cases reported. Furthermore, negative low-risk HPV testing does not preclude a diagnosis of FEH because HPV-13 and 32 are not frequently included.