Acquired Cleft Palate Associated with Febrile Illness

Abstract

While congenital cleft palate is thought to be an interaction of hereditary and environmental factors, acquired cleft palate (ACP) is caused commonly by cocaine inhalation in western countries. Other causes include infective (Tb, tertiary syphilis); trauma; connective tissue disease (SLE, vasculitis Wagner's granulomatosis; sarcoidosis and idiopathic. An uneducated 45-year-old presented with febrile skin eruption which evolved into skin necrolysis and gangrene. This occurred following the ingestion of quinine sulphate 650 mg orally, tds, for seven days in a remote village in Sudan. This was treated conservatively with antibiotics and steroids resulting in healing by fibrosis. The patient was presented with fixed drug eruption 48 hours after the ingestion of quinine for presumed Plasmodium falciparum malaria in our endemic area. On general examination it was found that she is having an incidental cleft palate that she is not aware of its presence. On further inquiry she and her family member were unaware of any past history of hyper-nasality, speech problems, feeding problems, repeated upper respiratory infection and insisted that the main reason for her was to seek medical advice related to her skin problems. However, she admitted the presence of hyper nasality at the time of admission. Having knowing their illiterate and poor social background, we had no option but to confirm or exclude the presence of acquired cleft palate.