Tan Jia Ying, Teo Guo Nian, Ng Ethan, Tay Andrew Ban Guan, Tay John Rong Hao
Private Practice, Singapore 428927, Singapore.
Department of Oral and Maxillofacial Surgery, National Dental Centre, Singapore 168938, Singapore.
J Clin Med. 2024 Feb 24;13(5):1285. doi: 10.3390/jcm13051285.
: There have been no reports of sepsis-induced agranulocytosis causing gingival necrosis in otherwise medically healthy patients to the authors' best knowledge. Even though there are several case reports of gingival necrosis secondary to medication-induced agranulocytosis, they have not systematically described the natural progression of agranulocytosis-related gingival necrosis. : This paper presents a case report of a 29-year-old female Indian patient with generalised gingival necrosis and constitutive signs of intermittent fever, nausea, and vomiting. She also complained of abdominal pains. Blood counts showed agranulocytosis, and the patient was admitted for a workup of the underlying cause. Parenteral broad-spectrum antibiotics were administered, which brought about clinical resolution. : Her gingival necrosis was attributed to sepsis-induced agranulocytosis triggered by bacteraemia, and upon clinical recovery, spontaneous exfoliation left behind exposed bone. Secondary healing over the exposed alveolar bone was noted after a year-long follow-up, albeit with some residual gingival recession. : Oral manifestations of gingival necrosis, when present with concomitant constitutive symptoms, could indicate a serious underlying systemic condition that could be potentially life-threatening if left untreated. Dentists should be cognizant of this possibility so that timely intervention is not delayed.
据作者所知,在其他方面身体健康的患者中,尚无败血症引起的粒细胞缺乏症导致牙龈坏死的报告。尽管有几例药物性粒细胞缺乏症继发牙龈坏死的病例报告,但它们并未系统地描述粒细胞缺乏症相关牙龈坏死的自然病程。本文报告了一例29岁的印度女性患者,该患者出现广泛性牙龈坏死,并伴有间歇性发热、恶心和呕吐等体征。她还诉说腹痛。血常规显示粒细胞缺乏症,患者因对潜在病因进行检查而入院。给予了肠外广谱抗生素治疗,临床症状得到缓解。她的牙龈坏死归因于菌血症引发的败血症性粒细胞缺乏症,临床恢复后,坏死组织自发脱落,留下暴露的骨组织。经过一年的随访,观察到暴露的牙槽骨实现了二期愈合,尽管仍有一些残留的牙龈退缩。当牙龈坏死的口腔表现伴有相应体征时,可能提示存在严重的潜在全身性疾病,如果不治疗可能会危及生命。牙医应认识到这种可能性,以便不延误及时干预。