Necrotizing stomatitis in the developed world

Abstract

We present a case of a malnourished 68-year old man with occult hypothyroidism who presented with malaise, pyrexia, tongue swelling, oral ulceration and dysphagia after a 6-month period of increasing lethargy and failing self-care. Severe necrotic oral ulcerative lesions were accompanied by cutaneous purpura, blood-filled blisters and bedsores. It was concluded that the patient's clinical condition reflected necrotizing stomatitis on a background of malnutrition with scorbutic skin lesions and hypothyroidism. The patient made a good recovery with scrupulous oral hygiene, debridement, intravenous metronidazole and nutritional support. Healing occurred with marked fibrosis and trismus, which has slowly improved with mouth-opening exercises. Necrotizing stomatitis is more commonly encountered in malnourished children in developing countries, and may subsequently result in devastating facial defects and death. Patients in the developed world with poor oral hygiene, malnourishment and immunosuppression are also at risk, but early diagnosis and treatment is life-saving and reduces subsequent disability.

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].…”

“…This is in line with the findings of other authors like Buchanan et al [3] and Agbelusi et al [1]. A biopsy of NS was not needed because its usually not indicated since the histology is not pathognomonic [7].…”

“…A study by Buchanan et al revealed NS in an HIVnegative malnourished 68-year-old man with occult hypothyroidism [3]. Malnutrition was the major underlying factor which was also seen in our patient because she was not feeding well.…”

“…Necrotizing stomatitis (NS) is an inflammatory disease of the oral cavity characterized by rapid destruction of epithelium, connective tissue, and dental papillae [3].…”

“…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].…”