ABSTRACT
Oral mucositis (OM) is a life-threatening side effect of chemo-radiotherapy. OM can provide a portal of entry for many microorganisms as coinfections which potentially generate other oral lesions. This case report describes a holistic approach to obtaining the successful treatment of OM with necrotizing ulcerative stomatitis (NUS) and oral candidiasis as coinfections in pediatric acute lymphoblastic leukemia (ALL). A 2-year-8-month-old boy was referred from the Pediatrics Department at Dr. Hasan Sadikin General Hospital with the chief complaint of canker sore and eating difficulty for the past two weeks. He had undergone the twelfth cycle of the last chemotherapy using methotrexate regimen. Extraoral examination revealed anemic conjunctiva, icteric sclera, and dry lips. Well-defined irregular multiple ulcers covered by yellowish to grayish pseudomembranous were found on the upper and lower labial mucosa, right and left buccal mucosa, tongue, palate, and gingiva. Potassium hydroxide (KOH) examination showed fungi in the oral lesions smear. The established diagnosis was OM with NUS and oral candidiasis as coinfections. Debridement was done using chlorine dioxide-zinc and 0.2% chlorhexidine gluconate. We collaborated with the pediatrician who prescribed ceftazidime, meropenem, and fluconazole, and also with parents. The holistic approach is beneficial and important in improving quality of life and supporting the successful treatment of OM with coinfections.
ABSTRACT
This case highlights the role of stress as trigger factor of HSV-1 reactivation causing recurrent intraoral herpes mimicking herpes-associated erythema multiforme (HAEM). A 24-year-old female came with chief complaints of pain in the oral cavity followed by painful swallowing and fever. She admitted under stress due to family problems and also had insomnia for the last three years. Extra-oral examination revealed serosanguineous crusts on lips that were painful and easily bleed. Intra-oral examination showed the white-yellowish multiple and coalescent ulcers, irregular, and painful on the left and right buccal mucosa, upper and lower labial mucosa, dorsum of the tongue, the floor of the mouth, and oropharynx. The results of the Depression Anxiety and Stress Scale (DASS)-21 examination were moderate depression, extremely severe anxiety, and moderate stress. The results of the HSV-1 IgG examination before and after therapy were positive with titer > 200 U/mL. Pharmacological therapy included acyclovir 200 mg tablets, multivitamin, benzydamine HCl lozenges, 0.025% hyaluronic acid mouthwash, 0.9% NaCl, and 100% petroleum jelly. Non-pharmacological therapy included stress management such as self-encouragement and referral to consult with a professional. This therapy generated significant result. In conclusion, stress affects many systems in the body, including the oral cavity. Stress is one of the trigger factors for HSV-1 reactivation which can cause oral manifestation. Early detection of trigger factors is important for better treatment result.
