A case report of chronic neutropenia: clinical and ultrastructural findings

Abstract

This case report of severe periodontitis concerns a young male patient with chrotiic idiopathic neutropenia seen between 1981 and 1983 by the School o'i Dental Medicine of Geneva and from 1984 to 1988 by the Eastman Dental Hospital of London. The patient was maintained by intermittent systemic antibiotics, subgingiva! chlorhexidine irrigatioti, conventional debridement, brushing, and wire-mesh and composite splmting of loose teeth. After leavmg school, at the patient's express wish, the extreme downhill pattern of the periodontitis resulted in removal of affected teeth and overdenture construction. The extracted teeth and associated soft tissues were examined for relevant plaque and host response features. The intact morphotypes associated with the advancing front of the lesion were invariably Gram-negative or positive coccoid cells, or less commonly short rods, as in all documented forms of periodotitis. Connective tissue destruction was associated with a leucocyte accumulation comprising mainly polymorphonuclear neutrophils (PMN) and plasma cells. Both were observed degenerated more deeply than in routine adult periodontitis, including PMN lysosome loss and lymphocyte maturation within peripheral blood vessels. Only in one instance, one part of the superficial connective tissue of one block contained bacteria. It was concluded that the features of plaque and the lesion suggest a typical first line of defence response as in other forms of periodontitis. From the consideration of the 10 years clinical history of the patient, it is clear that non-surgical management is possible even in extreme cases, without any compromise of the patient's oral or systemic health, and in accord with the patient's wishes.

Periodontal therapeutics – a viable option?

“…For while bacteria, and especially non-whole cell fractions may indeed translocate especially in the soft connective periodontal tissues with even minor stimulation, for example, tooth brushing, the chronicity of the CIPDs, and the contained histology indicate that even in the severest forms of periodontitis there is no evidence for invasion as the primary mechanism of tissue d e s t r u c t i~n '~~~~. Only when the host response is severely compromised, as for example in neutrophil disorders, will periodontitis tend to advance rapidly, and even then careful examination of the destroyed tissues rarely reveals intact microorganisms, and then not at increased levels21, 22.…”

Chronic benign neutropenia diagnosed due to severe stomatitis: a case report

“…Neutropenia is a condition in which number of neutrophils in the peripheral blood is decreased and is classified into several types 1) . There have been many case reports of severe neutropenia, such as cyclic and congenital neutropenia (Kostmann's syndrome), related to oral ulceration or gingivitis [6][7][8][9][10][11][12][13][14][15][16][17][18][19] . However, no case diagnosed as a result of detection of oral infectious lesions was found in our search of the literature.…”

Plaque and chronic inflammatory Periodontal disease A question of ecology

“…Rare translocation due to minor trauma may result in enhanced bacterial product entry, or, more infrequently, of bacteria. While one might make a case for such events being associated with episodes of tissue breakdown, no evidence has yet been produced for this, and bacteria are equally rare even in the severest periodontitis, for example, those associated with Papillon-Lefevre syndrome (Vrahopoulos et al 1988) or chronic neutropenia (Vaughan et al 1990). One may reasonably postulate trauma as an initiating factor.…”