Abstract
RATIONALE: Cancrum oris, also known as noma, is a rare and rapidly progressing gangrenous infection affecting the oral cavity, commonly seen in malnourished children. We discuss the clinical presentation, diagnostic dilemma and management in a 54-year-old male human immunodeficiency virus-positive patient with oral ulceration clinically resembling squamous cell carcinoma (SCC). PATIENT CONCERNS: The patient had severe oral ulceration with pain and difficulty eating food. DIAGNOSIS: Histopathological examination was misleading as it revealed features akin to early invasion of SCC. Immunohistochemistry findings were not in favour of SCC. TREATMENT: Antiretroviral therapy was started owing to the decreased CD4 cell count. OUTCOMES: Lesions began to show signs of healing on follow-up. TAKE-AWAY LESSONS: This case aims to highlight the unique challenges of diagnosing and emphasises the importance of considering opportunistic infections in immunocompromised patients presenting with oral ulcerations to prevent misdiagnosis and maltreatment.