Dental infection associated with exuberant gingival necrosis in a patient with paroxysmal nocturnal hemoglobinuria: A case report. (27th December 2020)

• Record Type: Journal Article
• Authors: Ximenes, Iury da Silva; Filho, Osias Vieira de Oliveira; Malta, Cássia Emanuella Nóbrega; Dantas, Thinalli Sousa; Alves, Ana Paula Negreiros Nunes; Mota, Mario Rogério Lima; Sousa, Fabrício Bitu
• Is Part Of: Special care in dentistry. Volume 41:Number 2(2021)
• Page Start: 277
• Page End: 281
• Publication Date: 2020-12-27
• Subjects: dentistry -- eculizumab -- mouth disorders -- necrosis -- paroxysmal nocturnal hemoglobinuria; People with disabilities -- Dental care -- Periodicals; Older people -- Dental care -- Periodicals; Hospital dental service -- Periodicals; Dental Care for Disabled -- Periodicals; Dental Service, Hospital -- Periodicals; Geriatric Dentistry -- Periodicals; 617.60087
• DOI: 10.1111/scd.12552
• Languages: English
• ISSNs: 0275-1879

Abstract

Abstract: Paroxysmal nocturnal hemoglobinuria (PNH) is a hematological disorder that affects hematopoietic stem cells. An association with other hematological diseases, such as hemolytic anemia and neutropenia, is observed with a high occurrence of aplastic anemia. The aim of the present study is to report a case of dental infection in a patient with PNH exhibiting exuberant gingival involvement. A 45‐year‐old male patient sought the Federal University of Ceara reporting severe toothache associated with tooth 24. Clinical examination revealed that the tooth was associated with an apparent fistula and a yellowish lesion with smooth surface located in the palate. The patient had interrupted the medication to control PNH. Blood transfusion was requested due to deficient hematological parameters. Tooth extraction and excisional biopsy were performed under antibiotic coverage. In the postoperative period, low‐level laser therapy (LLLT) was performed. Histopathological examination revealed connective tissue showing extensive necrotic areas, accumulation of basophilic material, numerous cyst‐like cavities, and degenerated cells. Histopathological findings were compatible with the initial clinical diagnosis of gingival necrosis. The patient evolved with febrile neutropenia, requiring hospitalization for 1 month. Improvement in the overall health was observed after the administration of antibiotics, eculizumab, and weekly LLLT at the biopsy site.