Severe necrotizing stomatitis and osteomyelitis after chemotherapy for acute leukaemia

Abstract

Background: Leukaemia is a malignant neoplasm characterized by clonal proliferation of white blood cells within the bone marrow. Despite an increase in the white blood cell count, the leukaemic leukocytes are non-functional. The oral complications arising in leukaemic patients can be attributed to the direct and indirect effects of immunosuppressive chemotherapy. Methods: This case report describes severe maxillary and mandibular necrotizing stomatitis and osteomyelitis in a young female patient after chemotherapy for acute leukaemia. On physical examination, the patient presented malnourished with pale skin, cervical lymphadenitis, frequent fever and generalized pain. The intra-oral clinical examination found halitosis, multiple ulcers, necrotizing stomatitis and osteomyelitis located in the maxillary and mandibular regions. The necrotizing stomatitis and osteomyelitis were treated locally with atraumatic removal of the necrotized tissues. The patient received a daily preventive protocol consisting of oral hygiene care, including twice daily brushing, and mouthrinses with a solution of chlorhexidine. She was also treated with systemic metronidazole and amoxicillin for 21 days. Results: During the course of management the patient's oral condition improved with some re-epithelialization being noted. However, severe alveolar bone destruction remained evident. Thirty-two months after presentation of the initial symptoms, the patient died due to complications related to leukaemia recurrence (haemorrhage, sepsis and respiratory distress syndrome). Conclusions: Dental monitoring during cancer treatment is imperative in order to emphasize the importance of dental plaque control and the maintenance of a healthy periodontal condition throughout medical treatment.

Necrotizing Stomatitis in a Non-HIV Patient: A Case Presentation

“…In our own case, the patient was HIV negative with underlying medical conditions which would have lowered her immunity, predisposing her to NS. This is similar to the finding of Buchanan et al [3] and Santos et al [15].…”

“…Another case was a malnourished old patient who developed NS following chemotherapy for leukemia [15]. This patient had more than one factor contributing to the development of NS.…”

“…The predisposing factors include anemia, malnutrition, physical and emotional stress, anemia, poor nutrition, smoking, recent illness (example, measles), agranulocytosis or neutropenia, chemotherapy, and immunosuppression [3,15].…”

Un cas de stomatite nécrosante : noma des pays riches ?

“…Il existe peu de cas de stomatites nécrosantes en rapport avec le MTX rapportés dans la littérature. Il s'agit le plus souvent de patients dénutris ou immunodéprimés [9][10][11].…”

“…Il s'agissait essentiellement d'ulcérations muqueuses profondes. Un autre cas a été observé chez un jeune patient atteint de leucémie aiguë traité entre autres avec du MTX [11] : il s'agissait de lésions nécrotiques extensives situées sur le palais dur, le palais mou et les piliers du voile.…”