title: Naso-orbicular tissue necrosis by Streptococcus parasanguis in a patient with Fanconi anemia: clinical and laboratory aspects.
abstract: Fanconi anemia (FA) is a rare autosomal recessive disorder, characterized by pancytopenia and progressive hypoplasia of the bone marrow. A 23-year-old woman with FA showed severe pancytopenia and developed an abscess on the infraorbicular region on the right side of the face that progressed to phlegmon and caused tissue necrosis of the nostrils, nasal septum, nasal fossa, and posterior orbital region. Laboratory examination showed Streptococcus parasanguis as the etiologic agent of the phlegmon. Supportive treatment was recommended due to donor incompatibility for bone marrow transplant. The intraoral examination showed spontaneous gingival bleeding, edema of the interdental papillae, hematomas on the superior and inferior lips, bacterial and fungal infections, and adequate oral hygiene. The patient was treated with the administration of an antibiotic (imipenem), an antifungal (amphotericin B), and mouth washing with antiseptic solutions. Periodontal prophylaxis and orientation to and control of oral hygiene and diet were also used during the remission period. For functional and esthetic rehabilitation of the alar regions and nasal dorsum, an acrylic resin nasal prosthesis was made, supported by a spectacle frame.
authors.affiliation: Department of Biosciences and Oral Diagnosis, São José dos Campos School of Dentistry, São Paulo State University-UNESP, São José dos Campos, São Paulo, Brazil. mfgomes@fosjc.unesp.br
authors.forename: Mónica Fernandes
authors.initials: MF
authors.lastname: Gomes
authors.forename: Raquel Teodoro Santos
authors.initials: RT
authors.lastname: Teixeira
authors.forename: Glauco
authors.initials: G
authors.lastname: Plens
authors.forename: Marcelo Miloni
authors.initials: MM
authors.lastname: Silva
authors.forename: Elitânia Marinho
authors.initials: EM
authors.lastname: Pontes
authors.forename: Joaŏ Carlos
authors.initials: JC
authors.lastname: da Rocha
mesh_terms: D000180:Acrylic Resins; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D005199:Fanconi Anemia / Q000150:complications*; D005260:Female; D006801:Humans; D009336:Necrosis; D009666:Nose; D009668:Nose Diseases / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D009916:Orbital Diseases / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D010198:Pancytopenia / Q000150:complications / Q000209:etiology; D019736:Prostheses and Implants; D013290:Streptococcal Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D013291:Streptococcus / Q000472:pathogenicity
chemical_list: D000180:Acrylic Resins; D000900:Anti-Bacterial Agents