Reactions 1070 - 24 Sep 2005

SAntineoplastics

Oral infections: case reportA 14-year-old boy developed oral bacterial and Candidia

albicans infections during treatment with antineoplastics foracute lymphoblastic leukaemia (ALL).

The boy had been receiving antineoplastics for variedintervals over 5 years [dosages not stated]; he had alsoreceived radiotherapy of the central nervous system. Duringtreatment of a second ALL relapse, he was hospitalised withbacterial and mycotic infections on his face, abdomen and oralcavity [duration of treatment before reaction onset not clearlystated]. He reported fever, a progressive swollen face, andstrong pain and burning in his mouth. On examination, he waspale, jaundiced, malnourished, cyanotic and had frequentfever, engorged cervical lymphadenitis and general aches andpains. He had right-sided facial asymmetry (he reportedsporadic relapses) with erythematous and hyperpigmentatedskin. On intraoral examination, he had ulcers in his palate withareas of extensive necrosis and pseudomembranes. Findingsfrom gingival examination were characteristic of acutenecrotising ulcerative gingivitis. His tongue was coated andhad no papillae. He had foul mouth odour and limited mouthopening. Exfoliative cytology was performed and he wasdiagnosed with mixed infection with C. albicans and bacteria.

The boy received imipenem and amphotericin B;mouthwash and removal of bacterial plaque wererecommended. Discreet chronic gingivitis, carious whitelesions and enamel hypoplasia were also observed in his teeth.Subsequently, he received oral prophylaxis with tartar removaland orientation and control of oral hygiene. Topical fluoridewas applied until the carious white lesions disappeared.During remission phase of ALL, he continued to have right-sided facial pigmentation and discreet asymmetry, but hadsignificant improvement in intraoral lesions. His tongue andpalate mucosae returned to normal.

Author comment: "During chemotherapy andradiotherapy there is an increase in the incidence and severityof infections and gingivitis, mainly during leukopenia periodswith consequent immunosuppression."Gomes MF, et al. Oral manifestations during chemotherapy for acutelymphoblastic leukemia: a case report. Quintessence International 36: 307-313, No.4, Apr 2005 - Brazil 807220912

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Reactions 24 Sep 2005 No. 10700114-9954/10/1070-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved