Oral Ulcers and Necrotizing Gingivitis in Relation to HIV-Associated Neutropenia: A Review and an Illustrative Case

Abstract

An unusual case of necrotizing gingivitis and neutropenic oral ulcers in an HIV-seropositive patient is presented. In spite of a very low CD4(+) T cell count and severe neutropenia, the necrotizing gingivitis responded favorably to standard periodontal treatment, and the oral ulcers healed after administration of granulocyte colony-stimulating factor (G-CSF). Nonspecific oral ulcers in HIV-seropositive subjects with neutropenia should be regarded as neutropenic ulcers. The term nonspecific ulcers should be restricted to those ulcers with nonspecific histopathological features in patients without neutropenia or a nutritional deficiency such as iron, folic acid, and vitamin B.

Enfermedades periodontales necrotizantes: factores de riesgo y tratamiento. Revisión sistemática

“…(Figura 1). De los 19 artículos revisados, según la guía GRADE (21) , el grado de evidencia es bajo en quince trabajos (5,11,12,15,18,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) y moderado en los otros cuatro (8,9,13,6) .…”

“…En esta revisión se cumplen 21 de los 27 ítems de la declaración PRISMA (20) . De los 19 artículos, 16 son reportes de casos (5,11,12,15,18,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) ; 1 es una serie de casos (8) ; 2 son ensayos aleatorios controlados (9,16) y 1 es un estudio de casos y controles (13) .…”

Oral manifestations in chronic neutropenia in adults: a case report

“…Secondary syphilis may also manifest as multiple oral lesions [8,11,[13][14][15][16][17][18]. Oral tuberculosis sometimes occurs with single or multiple ulcers [19,20].…”

Differential Diagnosis and Treatment Proposal for Acute Endodontic Infection

“…16 It is usually related to the release of stress hormones that alter the rates of T4/T8 lymphocytes, causing a decrease in the chemotaxis and the phagocytic response of neutrophils. 17 It clinically presents inflamed, edematous, and hemorrhagic interdental papillae (Fig. 4D).…”