Holistic Approach of a Leukemic Child Suffering from Oral Mucositis with Coinfections: A Case Report

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.

Antioxidant Effect of Mouthwash Containing Zinc, Aloe Vera, and Stabilized Chlorine Dioxide for Oral Manifestation of Acute Myeloblastic Leukemia (Aml)

“…In this study, the patient was received mouthwash containing zinc, Aloe vera, and SCD, for compressing the lips, every 1-2 h with a duration of 30 min. Zinc, which is a trace element, has an important role in the body's physiological processes, including immune system defense, cell membrane stability, and wound healing by increasing protein and nucleic acid synthesis, as well as increase oxygen transfer [24]. It has an antioxidant effect by giving electrons to ROS, neutralize the negative effects of ROS, and reducing oxidative stress, and the oxidation molecules [19].…”

“…SCD releases oxygen to kill the anaerobic bacteria. It also has antiviral, anti-fungicidal, and antibacterial effects and maintains a normal pH in the oral cavity [13,24] The use of CD has made it possible to establish that 1) it is safe for local application without risk of systemic intoxication, 2) it does not intervene in the healing process, 3) it is effective even at low concentrations and 4) it does not generate antimicrobial resistance [14].…”