Polymicrobial infection of the oral mucosa after hematopoietic stem cell transplantation. Case report

Ramos, Gabriela de Assis; Piragibe, Maria Midori Miura; Moreira, Maria Cláudia Rodrigues; Antunes, Héliton Spíndola

doi:10.1016/j.htct.2019.02.003

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…Symptomatic ulcers are the most common clinical manifestation of viral infections. 2,[8][9][10][11] However, the clinical pattern had changed in our patient, with lesions evolving into exophytic plaques and nodules in different regions of the mouth. Atypical manifestations of viral skin infections have already been described, varying from vesicles to nodules, hypertrophic patterns, and verrucous plaques.…”

Section: Discussionmentioning

confidence: 65%

“…17 Viral cytopathic effect identification can be challenging, especially when infected cells are sparse and associated with an intense inflammatory infiltrate. 6 However, Ramos et al 9 reported a case in which exfoliative cytology was crucial in establishing polymicrobial infection diagnosis in a patient whose condition did not allow performing a surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

“…11 Differential diagnoses of the oral lesions in immunosuppressed patients should include graft versus host disease (GVHD) and secondary viral (HSV, CMV, and varicellazoster virus [VZV]), fungal, and bacterial infections. 9 There is a consensus in the literature regarding the use of antiviral agents for HSV infection management. 4,11 Viral infection prophylaxis is associated with a low mortality rate.…”

Section: Introductionmentioning

confidence: 99%

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Atypical oral viral coinfection after allogeneic hematopoietic stem cell transplantation: Diagnosis and treatment challenge

Schepanski

Machado

Sola

et al. 2021

Special Care in Dentistry

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Background: Viral reactivation in patients undergoing immunosuppressive therapy after hematopoietic stem cell transplantation (HSCT) is a serious complication associated with significant morbidity and mortality. Infections caused by human herpes viruses such as herpes simplex virus (HSV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) can result in oral lesions. Case Presentation: A 40-year-old male patient who had undergone HSCT presented with ulcerated lesions in different areas of the mouth, for 7 months. The lesions had evolved to painful exophytic nodules with an erythematous, ulcerated surface. They were present on the tongue margins and soft and hard palate.Histological, immunohistochemical (IHC), and polymerase chain reaction analyses were performed, and the results were compatible with HSV-1 and -2 and CMV infections. Treatment comprised five sessions of antimicrobial photodynamic therapy (aPDT) and oral valganciclovir. Thirty days after combined antiviral therapy and aPDT, the lesions were completely resolved. Patient was followed up for 12 months without recurrence. Conclusion:Diagnosis and treatment of atypical oral infections in immunosuppressed patients is challenging. Assessment of both clinical and laboratory findings is mandatory for a conclusive diagnosis. The use of local antimicrobial and systemic therapies contributes to positive clinical response in such cases.

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